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NPI Code Detail

MEDICARE: VELVET V MEDLOCK MSPT

MEDICARE: VELVET V MEDLOCK MSPT
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
1225100000XPhysical TherapistPT1835AR
2225100000XPhysical Therapist4397OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558324020
Entity Type Code : Individual
Provider Name (Legal Business Name) : VELVET V MEDLOCK MSPT
Provider Business Mailing Address
First Line : PO BOX 11122
Second Line :
City : FORT SMITH
State : AR
Zip : 72917-1122
Country : US
Telephone Number : 479-452-7773
Fax Number : 479-452-7774
Provider Business Practice Location Address
First Line : 5905 REMINGTON CIR
Second Line :
City : FORT SMITH
State : AR
Zip : 72903-6523
Country : US
Telephone Number : 479-452-7773
Fax Number : 479-452-7774
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/07/2006
Last Update Date : 09/06/2013

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Directions to “ VELVET V MEDLOCK MSPT” Practice Location

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