MEDICARE: LITTLE ROCK PHYSICAL MEDICINE AND REHABLITATION

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	2251C2600X	Cardiopulmonary Physical Therapist

General Provider Information

NPI Number	:	1164684080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LITTLE ROCK PHYSICAL MEDICINE AND REHABLITATION

Provider Business Mailing Address
First Line	:	11400A HURON LN
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72211-1847
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11400A HURON LN
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72211-1847
Country	:	US
Telephone Number	:	501-588-4478
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. DAVID BAKER
Credential	:
Telephone Number	:	501-588-4478

Provider Enumeration Date	:	07/01/2008
Last Update Date	:	07/01/2008

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Directions to “LITTLE ROCK PHYSICAL MEDICINE AND REHABLITATION ” Practice Location

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