Organization
CUSTOM CARE THERAPY CORP.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL COLE CHAFFIN MSPT (PHYSICAL THERAPIST)
(501) 812-6451
Entity
Organization
Contact information
Practice address
4600 EDGEMERE ST, N LITTLE ROCK, AR 72116-7424
(501) 812-6451
(501) 812-6451
Mailing address
4600 EDGEMERE ST, N LITTLE ROCK, AR 72116-7424
(501) 812-6451
(501) 812-6451
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1583
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5T405
BLUE CROSS BLUE SHIELD
AR
Enumeration date
04/03/2007
Last updated
08/22/2020
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