Organization
GROVE STREET PHYSICAL THERPAY CLINIC & REHAB SVCS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUZY G BURSON (PRESIDENT)
(870) 862-4042
Entity
Organization
Contact information
Practice address
203 W GROVE ST, EL DORADO, AR 71730-4646
(870) 862-4042
(870) 864-0218
Mailing address
203 W GROVE ST, EL DORADO, AR 71730-4646
(870) 862-4042
(870) 864-0218
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5C239
ARK BLUE CROSS B/S
AR
Enumeration date
01/24/2006
Last updated
08/22/2020
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