Organization
PHYSICAL THERAPY ADVANTAGE, LLC
Active
Other names
Check Home Safety.com
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KELLEY GLENN DPT (PHYSICAL THERAPIST)
(501) 519-0144
Entity
Organization
Contact information
Practice address
52 DUCLAIR CT, LITTLE ROCK, AR 72223-9570
(501) 519-0144
Mailing address
52 DUCLAIR CT, LITTLE ROCK, AR 72223-9570
(501) 519-0144
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
1240
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1225144793
KELLEY GLENN
AR
Enumeration date
05/01/2012
Last updated
05/01/2012
Update your record
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