MEDICARE: MOUNTAINCREST REHABILITATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center	4153	AR

General Provider Information

NPI Number	:	1124579164
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAINCREST REHABILITATION

Provider Business Mailing Address
First Line	:	1801 FOREST HILLS BLVD
Second Line	:
City	:	BELLA VISTA
State	:	AR
Zip	:	72715-3016
Country	:	US
Telephone Number	:	479-855-9348
Fax Number	:	479-855-9358

Provider Business Practice Location Address
First Line	:	1801 FOREST HILLS BLVD
Second Line	:
City	:	BELLA VISTA
State	:	AR
Zip	:	72715-3016
Country	:	US
Telephone Number	:	479-855-9348
Fax Number	:	479-855-9358

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	STEWART ONG
Credential	:
Telephone Number	:	479-236-4987

Provider Enumeration Date	:	10/14/2016
Last Update Date	:	10/14/2016

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1821251273 — DR. ALISA JOY JOHNSON L.M.T., PH.D.
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1902101322 — MR. JOHN J BANIA PTA
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1477835213 — MR. SHANE LEDREW FINK LPTA
Practice Location Address:

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Directions to “MOUNTAINCREST REHABILITATION ” Practice Location

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