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
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