Organization
GENESIS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL DAVID PTA (PHYSICAL THERAPY ASSISTANT)
(479) 330-0187
Entity
Organization
Contact information
Practice address
1513 S DIXIELAND RD, ROGERS, AR 72758-4935
(479) 636-5841
Mailing address
4106 CANDLEWOOD PL, ROGERS, AR 72758-8253
(479) 263-1268
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
OTR1586
AR
Other
Enumeration date
10/23/2012
Last updated
10/23/2012
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