Organization Name: | LONOKE PHYSICAL THERAPY, INC |
NPI Number: | 1992706477 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MATT H JACKSON (PRESIDENT/PT) |
Mailing Address: | 1515 N Center St #3 Lonoke |
State: | AR US |
Postal Code: | 720862101 |
Phone Number: | 5016765540 |
Fax Number: | 5016766499 |
NPI Enumeration Date: | 08/09/2005 |
NPI Last Update Date: | 08/24/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2000X |
License Number: | PT1452 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AR |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Physical Therapy |
Taxonomy Definition: |