Provider Demographics
NPI:1194892406
Name:PHYSICAL THERAPY CENTER OF SOUTH ARKANSAS INC
Entity type:Organization
Organization Name:PHYSICAL THERAPY CENTER OF SOUTH ARKANSAS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:CLINTON
Authorized Official - Last Name:RHODES
Authorized Official - Suffix:
Authorized Official - Credentials:MS PT
Authorized Official - Phone:870-863-5100
Mailing Address - Street 1:215 N NEWTON AVE
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-5421
Mailing Address - Country:US
Mailing Address - Phone:870-863-5100
Mailing Address - Fax:870-863-5102
Practice Address - Street 1:215 N NEWTON AVE
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-5421
Practice Address - Country:US
Practice Address - Phone:870-863-5100
Practice Address - Fax:870-863-5102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT2026261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARDC1211OtherMEDICARE RAILROAD
AR5F055OtherBLUE CROSS BLUE SHIELD
AR5F055OtherBLUE CROSS BLUE SHIELD