Provider Demographics
NPI:1548514144
Name:CHARTON PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:CHARTON PHYSICAL THERAPY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARTON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:501-733-7597
Mailing Address - Street 1:100 WALMART DR
Mailing Address - Street 2:STE 5
Mailing Address - City:MORRILTON
Mailing Address - State:AR
Mailing Address - Zip Code:72110-4522
Mailing Address - Country:US
Mailing Address - Phone:501-477-2202
Mailing Address - Fax:501-421-0543
Practice Address - Street 1:100 WALMART DR
Practice Address - Street 2:STE 5
Practice Address - City:MORRILTON
Practice Address - State:AR
Practice Address - Zip Code:72110-4522
Practice Address - Country:US
Practice Address - Phone:501-477-2202
Practice Address - Fax:501-421-0543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-04
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR196314742Medicaid
270612OtherMEDICARE PTAN