Provider Demographics
NPI:1285611731
Name:MCH PHYSICAL THERAPY CLINIC, INC.
Entity type:Organization
Organization Name:MCH PHYSICAL THERAPY CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CECELIA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:CRATER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:501-223-8996
Mailing Address - Street 1:1 TREASURE HILL RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-2219
Mailing Address - Country:US
Mailing Address - Phone:501-223-8996
Mailing Address - Fax:501-223-8998
Practice Address - Street 1:1 TREASURE HILL RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-2219
Practice Address - Country:US
Practice Address - Phone:501-223-8996
Practice Address - Fax:501-223-8998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT 613225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR56128Medicare ID - Type UnspecifiedPTIP