Organization
NORTHSIDE THERAPY CENTER INC
Active
Organization
NORTHSIDE THERAPY CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STANLEY JENKINS HARRIS PT, DPT (PHYSICAL THERAPIST OWNER)
(501) 687-0328
Entity
Organization
Contact information
Practice address
4216 E MCCAIN BLVD, NORTH LITTLE ROCK, AR 72117
(501) 687-0328
(501) 687-0330
Mailing address
4216 E MCCAIN BLVD, NORTH LITTLE ROCK, AR 72117
(501) 687-0328
(501) 687-0330
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
0000001458
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4439380001
PALMETTO GBA DME
AR
01
—
5C512
BLUE CROSS BLUE SHIELD
AR
01
—
682617
ACN PROVIDER NUMBER
AR
01
—
7891261
AETNA
AR
01
—
CJ8952
PALMETTO RAILROAD MCARE
AR
Enumeration date
06/20/2006
Last updated
04/20/2008
Update your record
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