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General NPI Number Information
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NPI Number | 1922309475
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Entity Type | Organization
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Legal Business Name | THERAPEUTIC EXERCISE REHABILITATION & WELLNESS, INC
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Dates
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Enumeration Date | 11/14/2010
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Last Update Date | 02/27/2021
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Provider Practice Location Address
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Address Line | 1728 WESTWOOD CV
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City | JONESBORO
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State | AR
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Zip | 72401-4793
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Country | US
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Telephone | 870-292-9280
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Fax |
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Provider Business Mailing Address
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Address Line | 1728 WESTWOOD CV
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City | JONESBORO
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State | AR
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Zip | 72401-4793
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Country | US
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Telephone | 870-292-9280
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DARTELL DANTE TREADWELL
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Credential |
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Telephone | 870-292-9280
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT3059
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License Number State | AR
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