Organization
RIVER VALLEY THERAPY & SPORTS MEDICINE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GABE FREYALDENHOVEN P.T. (OWNER)
(479) 968-2525
Entity
Organization
Contact information
Practice address
2100 W MAIN ST, RUSSELLVILLE, AR 72801-2758
(479) 968-2525
(479) 968-2538
Mailing address
2100 W MAIN ST, RUSSELLVILLE, AR 72801-2758
(479) 968-2525
(479) 968-2538
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
145301742
—
AR
01
—
5C556
BLUE CROSS BLUE SHIELD
AR
01
—
662725
HEALTHLINK
AR
01
—
A001
TRICARE
AR
01
—
DA9917
PALMETTO GI RAILROAD
AR
Enumeration date
05/04/2006
Last updated
06/12/2019
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