Basic Information
| Provider Information | |||||||||
| NPI: | 1992706477 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LONOKE PHYSICAL THERAPY, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1515 N CENTER ST | ||||||||
| Address2: | #3 | ||||||||
| City: | LONOKE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720862101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016765540 | ||||||||
| FaxNumber: | 5016766499 | ||||||||
| Practice Location | |||||||||
| Address1: | 1515 N CENTER ST | ||||||||
| Address2: | #3 | ||||||||
| City: | LONOKE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720862101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016765540 | ||||||||
| FaxNumber: | 5016766499 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2005 | ||||||||
| LastUpdateDate: | 08/24/2007 | ||||||||
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| AuthorizedOfficialLastName: | JACKSON | ||||||||
| AuthorizedOfficialFirstName: | MATT | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/PT | ||||||||
| AuthorizedOfficialTelephone: | 5016765540 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MSPT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | PT1452 | AR | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.