1346245842 NPI number — APTC OF NORTH LITTLE ROCK, INC

Table of content: (NPI 1346245842)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346245842 NPI number — APTC OF NORTH LITTLE ROCK, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
APTC OF NORTH LITTLE ROCK, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ADVANCED PHYSICAL THERAPY OF NORTH LITTLE ROCK
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346245842
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/07/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4540 JOHN F KENNEDY BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72116-7309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-758-5555
Provider Business Mailing Address Fax Number:
501-758-5941

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4540 JOHN F KENNEDY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72116-7309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-758-5555
Provider Business Practice Location Address Fax Number:
501-758-5941
Provider Enumeration Date:
06/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HOLLAND
Authorized Official First Name:
MELISSA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
501-224-5454

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  0000000192 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4657970 . This is a "AETNA" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: P00855769 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: DA7015 . This is a "RAILROAD MEDICARE GROUP" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 130502742 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00855756 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 374964900 . This is a "OWCP: OFFICE OF WORK COMP" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 5F776 . This is a "MEDICARE NUMBER" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: DN8325 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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