MEDICARE: SHERIDAN PHYSICAL THERAPY CLINIC

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	2251P0200X	Pediatric Physical Therapist	PT860	AR
2	225100000X	Physical Therapist	PT860	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5S214	OTHER	AR	BCBS - INDIVIDUAL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730188350
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHERIDAN PHYSICAL THERAPY CLINIC

Provider Business Mailing Address
First Line	:	15 OPPORTUNITY DR
Second Line	:
City	:	SHERIDAN
State	:	AR
Zip	:	72150-9185
Country	:	US
Telephone Number	:	870-942-8335
Fax Number	:	870-942-2234

Provider Business Practice Location Address
First Line	:	15 OPPORTUNITY DR
Second Line	:
City	:	SHERIDAN
State	:	AR
Zip	:	72150-9185
Country	:	US
Telephone Number	:	870-942-8335
Fax Number	:	870-942-2234

Authorized Official
Title or Position	:	DIRECTOR AND OWNER
Name	:	MR. ROGER W SAENGER
Credential	:	RPT
Telephone Number	:	870-942-8335

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	10/24/2008

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Directions to “SHERIDAN PHYSICAL THERAPY CLINIC ” Practice Location

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