Provider Demographics
NPI:1962861054
Name:SPA CITY THERAPY, INC.
Entity type:Organization
Organization Name:SPA CITY THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:D
Authorized Official - Last Name:SOWERBUTTS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PT
Authorized Official - Phone:501-525-2273
Mailing Address - Street 1:1635 HIGDON FERRY RD
Mailing Address - Street 2:STE G
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-6913
Mailing Address - Country:US
Mailing Address - Phone:501-525-2273
Mailing Address - Fax:
Practice Address - Street 1:1635 HIGDON FERRY RD
Practice Address - Street 2:STE G
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6913
Practice Address - Country:US
Practice Address - Phone:501-525-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPA CITY THERAPY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-17
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR148913742Medicaid
AR5C629Medicare UPIN