Organization
EARLY LEARNING PEDIATRIC THERAPY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT TALLON (PRESIDENT)
(501) 985-2323
Entity
Organization
Contact information
Practice address
1701 S HIGHWAY 161, JACKSONVILLE, AR 72076-5508
(501) 985-2323
Mailing address
604 GRANDVIEW ST, SHERWOOD, AR 72120-3224
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
05
—
187287742
—
AR
Enumeration date
07/14/2011
Last updated
07/14/2011
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