Provider Demographics
NPI:1568856128
Name:BLUEPARK THERAPY, INC.
Entity type:Organization
Organization Name:BLUEPARK THERAPY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:FREYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-908-3651
Mailing Address - Street 1:PO BOX 241911
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-0017
Mailing Address - Country:US
Mailing Address - Phone:501-908-3651
Mailing Address - Fax:
Practice Address - Street 1:15 TAYLOR PARK LOOP
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211
Practice Address - Country:US
Practice Address - Phone:501-908-3651
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-22
Last Update Date:2018-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty