Organization
RIVER VALLEY PEDIATRIC THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SARA J WHITLOCK (OWNER)
(479) 890-5494
Entity
Organization
Contact information
Practice address
2703 W MAIN ST, RUSSELLVILLE, AR 72801-2456
(479) 890-5494
(479) 968-0069
Mailing address
PO BOX 9178, RUSSELLVILLE, AR 72811-9178
(479) 968-4273
(479) 968-1363
Taxonomy
Speciality
Code
Description
License number
State
2081P0010X
Pediatric Rehabilitation Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BCBS
BCBS
AR
Enumeration date
06/08/2006
Last updated
08/22/2020
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