Provider Demographics
NPI:1811081268
Name:MCBRIDE REHABILITATION GROUP LLC
Entity type:Organization
Organization Name:MCBRIDE REHABILITATION GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCBRIDE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:870-425-5881
Mailing Address - Street 1:PO BOX 1507
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72654-1507
Mailing Address - Country:US
Mailing Address - Phone:870-425-5881
Mailing Address - Fax:870-425-5966
Practice Address - Street 1:978 COLEY DRIVE
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653
Practice Address - Country:US
Practice Address - Phone:870-425-5881
Practice Address - Fax:870-425-5966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT1458261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR046570Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER