Provider Demographics
NPI:1194753160
Name:M.J. ORELLANO, PT PA
Entity type:Organization
Organization Name:M.J. ORELLANO, PT PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:ORELLANO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:501-227-9920
Mailing Address - Street 1:PO BOX 17050
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72222-7050
Mailing Address - Country:US
Mailing Address - Phone:501-227-9920
Mailing Address - Fax:
Practice Address - Street 1:12600 CANTRELL RD # 200
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-1604
Practice Address - Country:US
Practice Address - Phone:501-227-9920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT628225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR59351Medicare ID - Type UnspecifiedPROVIDER NUMBER