MEDICARE: WORKPLACE PHYSICAL THERAPY

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	332B00000X	Durable Medical Equipment & Medical Supplies	2200	AR

General Provider Information

NPI Number	:	1639390917
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WORKPLACE PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	PO BOX 6253
Second Line	:
City	:	SHERWOOD
State	:	AR
Zip	:	72124-6253
Country	:	US
Telephone Number	:	501-833-2675
Fax Number	:	501-833-0325

Provider Business Practice Location Address
First Line	:	825 TRAMMEL RD
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72117-2155
Country	:	US
Telephone Number	:	501-833-2675
Fax Number	:	501-833-0325

Authorized Official
Title or Position	:	PRESIDENT OWNER
Name	:	VAN DAVIS
Credential	:	MSPT
Telephone Number	:	501-833-2675

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	08/22/2008

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Directions to “WORKPLACE PHYSICAL THERAPY ” Practice Location

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