Basic Information
| Provider Information | |||||||||
| NPI: | 1881788875 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | A. YUMANG REHAB SERVICES, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 871 | ||||||||
| Address2: | |||||||||
| City: | TONTITOWN | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727700871 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4797513900 | ||||||||
| FaxNumber: | 4797513011 | ||||||||
| Practice Location | |||||||||
| Address1: | 3061 N MARKET AVE | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727033515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4794446277 | ||||||||
| FaxNumber: | 4794446278 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | YUMANG | ||||||||
| AuthorizedOfficialFirstName: | RAY | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER, PHYSICAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 4797513900 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT, LMT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 5C504 | 01 | AR | AR. BLUE CROSS | OTHER |