Basic Information
| Provider Information | |||||||||
| NPI: | 1417198482 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | REGIONAL THERAPY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5302 VILLAGE PKWY | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | ROGERS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727588102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4794640200 | ||||||||
| FaxNumber: | 4794648098 | ||||||||
| Practice Location | |||||||||
| Address1: | 3101 SE 14TH ST | ||||||||
| Address2: | |||||||||
| City: | BENTONVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727124900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4799866084 | ||||||||
| FaxNumber: | 4799866107 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2009 | ||||||||
| LastUpdateDate: | 03/20/2009 | ||||||||
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| AuthorizedOfficialLastName: | ALEXANDER | ||||||||
| AuthorizedOfficialFirstName: | JERRY | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT OF OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 4792468281 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.