Organization
COULTER PHYSICAL THERAPY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SETH B. COULTER P.T. (OWNER)
(479) 967-5155
Entity
Organization
Contact information
Practice address
115 SKYLINE DR, SUITE A, RUSSELLVILLE, AR 72802-3310
(479) 967-5155
(479) 967-5141
Mailing address
115 SKYLINE DR, SUITE A, RUSSELLVILLE, AR 72802-3310
(479) 967-5155
(479) 967-5141
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
117394742
—
AR
01
—
5C407
BLUE CROSS PROVIDER NUMBE
AR
Enumeration date
11/04/2005
Last updated
03/18/2008
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