Basic Information
| Provider Information | |||||||||
| NPI: | 1346245842 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | APTC OF NORTH LITTLE ROCK, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ADVANCED PHYSICAL THERAPY OF NORTH LITTLE ROCK | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4540 JOHN F KENNEDY BLVD | ||||||||
| Address2: | |||||||||
| City: | NORTH LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721167309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5017585555 | ||||||||
| FaxNumber: | 5017585941 | ||||||||
| Practice Location | |||||||||
| Address1: | 4540 JOHN F KENNEDY BLVD | ||||||||
| Address2: | |||||||||
| City: | NORTH LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721167309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5017585555 | ||||||||
| FaxNumber: | 5017585941 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2005 | ||||||||
| LastUpdateDate: | 07/07/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HOLLAND | ||||||||
| AuthorizedOfficialFirstName: | MELISSA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5012245454 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 07/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 0000000192 | AR | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 4657970 | 01 | AR | AETNA | OTHER | P00855769 | 01 | AR | RAILROAD MEDICARE | OTHER | DA7015 | 01 | AR | RAILROAD MEDICARE GROUP | OTHER | 130502742 | 05 | AR | MEDICAID | P00855756 | 01 | AR | RAILROAD MEDICARE | OTHER | 374964900 | 01 | AR | OWCP: OFFICE OF WORK COMP | OTHER | 5F776 | 01 | AR | MEDICARE NUMBER | OTHER | DN8325 | 01 | AR | MEDICARE RAILROAD | OTHER |