Provider Demographics
NPI:1215267679
Name:THEREX WELLNESS AND REHABILITATION
Entity type:Organization
Organization Name:THEREX WELLNESS AND REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARTELL
Authorized Official - Middle Name:DANTE
Authorized Official - Last Name:TREADWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:870-926-0271
Mailing Address - Street 1:3704 S CARAWAY RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-0656
Mailing Address - Country:US
Mailing Address - Phone:870-926-0271
Mailing Address - Fax:
Practice Address - Street 1:3704 S CARAWAY RD
Practice Address - Street 2:SUITE 4
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-0656
Practice Address - Country:US
Practice Address - Phone:870-926-0271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-07
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3059225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3730146OtherMEDICARE GROUP NUMBER