Organization
HOME CARE PEDIATRIC THERAPY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT EDWARD VOGLER PT (SECRETARY)
(479) 858-6144
Entity
Organization
Contact information
Practice address
2315 HONEYSUCKLE LN, RUSSELLVILLE, AR 72801-5526
(479) 858-6144
(479) 858-6144
Mailing address
2315 HONEYSUCKLE LN, RUSSELLVILLE, AR 72801-5526
(479) 858-6144
(479) 858-6144
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5C377
ABCBS PROVIDER NUMBER
AR
Enumeration date
10/16/2006
Last updated
08/22/2020
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