Provider Demographics
NPI:1861594673
Name:PHYSIQUES, INC.
Entity type:Organization
Organization Name:PHYSIQUES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:BSE, RN
Authorized Official - Phone:870-234-3488
Mailing Address - Street 1:PO BOX 94
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:AR
Mailing Address - Zip Code:71754-0094
Mailing Address - Country:US
Mailing Address - Phone:870-234-3488
Mailing Address - Fax:870-234-0143
Practice Address - Street 1:1010 N DUDNEY RD STE D
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:AR
Practice Address - Zip Code:71753-2651
Practice Address - Country:US
Practice Address - Phone:870-234-3488
Practice Address - Fax:870-234-0143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR208100000X, 261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR148073002Medicaid
AR337810Medicare PIN
AR5C128Medicare PIN