Provider Demographics
NPI:1700918471
Name:PHYSICAL THERAPY CONNECTION, INC.
Entity type:Organization
Organization Name:PHYSICAL THERAPY CONNECTION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:870-424-4550
Mailing Address - Street 1:PO BOX 587
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72654-0587
Mailing Address - Country:US
Mailing Address - Phone:870-424-4550
Mailing Address - Fax:870-424-4558
Practice Address - Street 1:1027 HIGHWAY 62 E
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-3215
Practice Address - Country:US
Practice Address - Phone:870-424-4550
Practice Address - Fax:870-424-4558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT1978174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty