Provider Demographics
NPI:1699143321
Name:OMNIS REHAB L.L.C
Entity type:Organization
Organization Name:OMNIS REHAB L.L.C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REX PAUL
Authorized Official - Middle Name:BRADY
Authorized Official - Last Name:DECLERK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:501-454-4528
Mailing Address - Street 1:12120 COLONEL GLENN RD STE 6200
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72210-2370
Mailing Address - Country:US
Mailing Address - Phone:501-313-2844
Mailing Address - Fax:
Practice Address - Street 1:12120 COLONEL GLENN RD STE 5200
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72210-2824
Practice Address - Country:US
Practice Address - Phone:501-454-4528
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-11
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR15639111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty