Provider Demographics
NPI:1316150162
Name:DEAN S. BUTLER HOPE PHYSICAL THERAPY CENTER
Entity type:Organization
Organization Name:DEAN S. BUTLER HOPE PHYSICAL THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CUSTOMER SERVICE REP
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-327-1727
Mailing Address - Street 1:PO BOX 1203
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:AR
Mailing Address - Zip Code:71802-1203
Mailing Address - Country:US
Mailing Address - Phone:870-777-9359
Mailing Address - Fax:870-777-0188
Practice Address - Street 1:1405 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HOPE
Practice Address - State:AR
Practice Address - Zip Code:71801-7244
Practice Address - Country:US
Practice Address - Phone:870-777-9359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT478225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR125213742Medicaid
AR56134OtherARKANSAS BLUE CROSS
AR56134Medicare ID - Type Unspecified