Provider Demographics
NPI:1841299658
Name:HARRISON PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:HARRISON PHYSICAL THERAPY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHENANDOAH
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BORCHERS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:870-743-4438
Mailing Address - Street 1:1420 HIGHWAY 62 65 N STE A
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-1959
Mailing Address - Country:US
Mailing Address - Phone:870-743-4438
Mailing Address - Fax:870-741-0736
Practice Address - Street 1:1420 HIGHWAY 62 65 N STE A
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-1959
Practice Address - Country:US
Practice Address - Phone:870-743-4438
Practice Address - Fax:870-741-0736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT1784225100000X
AROTR423225X00000X
ARPT782225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR139354742Medicaid
AR139354742Medicaid