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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