Organization
PRISTINE HEALTH LLC
Active
Organization
PRISTINE HEALTH LLC
Active
Other names
AthletePlus Physical Therapy and Sports Performance
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DANIEL CHRIS COTHERN (OWNER/PHYSICAL THERAPIST)
(479) 751-8437
Entity
Organization
Contact information
Practice address
7058 W SUNSET AVE, SUITE 9A, SPRINGDALE, AR 72762-0680
(479) 751-8437
(479) 802-0575
Mailing address
7058 W SUNSET AVE, SUITE 9A, SPRINGDALE, AR 72762-0680
(479) 751-8437
(479) 802-0575
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
2286
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
046601
MEDICARE PTAN
AR
05
—
163436721
—
AR
01
—
5A004
BLUE CROSS BLUE SHIELD
AR
Enumeration date
08/05/2007
Last updated
03/16/2012
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