Organization
MAUMELLE PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNY A DE LUCA P.T. (OWNER)
(501) 753-2201
Entity
Organization
Contact information
Practice address
9843 MAUMELLE BLVD, NORTH LITTLE ROCK, AR 72113-7027
(501) 851-6600
(501) 851-6643
Mailing address
PO BOX 13567, MAUMELLE, AR 72113-0567
(501) 753-2201
(501) 753-2207
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT2475
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
157828742
—
AR
01
—
5F332
AR BCBS
AR
Enumeration date
11/30/2005
Last updated
02/17/2010
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