Organization
EQUESTRIAN ZONE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JODI KUSTURIN PT (DIRECTOR)
(479) 970-8351
Entity
Organization
Contact information
Practice address
4800 S FRANKFORT AVE, RUSSELLVILLE, AR 72802-0823
(479) 970-8351
(479) 967-1178
Mailing address
PO BOX 282, RUSSELLVILLE, AR 72811-0282
(479) 970-8351
(479) 967-1178
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Enumeration date
04/18/2018
Last updated
04/18/2018
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