1720387145 NPI number — GAYLA LIKE PHYSICAL THERAPY, INC

Table of content: (NPI 1720387145)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720387145 NPI number — GAYLA LIKE PHYSICAL THERAPY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GAYLA LIKE PHYSICAL THERAPY, 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:
Provider Other Organization Name Type Code:
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:
1720387145
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
311 SFC 1003
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLT
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72326-8516
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-633-4443
Provider Business Mailing Address Fax Number:
870-633-0647

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
311 SFC 1003
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLT
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72326-8516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-633-4443
Provider Business Practice Location Address Fax Number:
870-633-0647
Provider Enumeration Date:
03/24/2011

Additional Information

Authorized Official

Authorized Official Last Name:
LIKE
Authorized Official First Name:
GAYLA
Authorized Official Middle Name:
DEANNA
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
870-633-4443

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT2967 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 235Z00000X , with the licence number: SP#2616 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2024 www.npivalidator.com