Organization
KIDSOURCE THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. COREY W TINKLE MS PT (MS PT VP)
(501) 315-4415
Entity
Organization
Contact information
Practice address
17706 I-30, STE 3, BENTON, AR 72015
(501) 315-4414
(501) 315-3467
Mailing address
17706 I-30, STE 3, BENTON, AR 72015
(501) 315-4414
(501) 315-3467
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5C299
BCBS
AR
Enumeration date
03/31/2006
Last updated
09/11/2025
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