NPIMap

Organization Active NPI

Blue Rose Physical Therapy - West Little Rock LLC

Doing business as Blue Rose Physical Therapy - West Little Rock

  • Physical Therapy Clinic/Center
  • Little Rock, AR
National Provider Identifier
1003636630
Registry record updated Nov 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
BLUE ROSE PHYSICAL THERAPY - WEST LITTLE ROCK LLC
Doing business as
Blue Rose Physical Therapy - West Little Rock
Practice address
1 Huntington Rd
Little Rock, AR 72227-2306
Phone
(501) 904-2778
Fax
(866) 724-7887
NPI assigned
Oct 17, 2024
Last updated
Nov 7, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Logan Dockery, DRNPI 1609442250
Title
Owner/Ceo
Phone
(501) 802-2844

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X Primary
Physical Therapist 225100000X

Addresses

Primary practice location

1 Huntington Rd
Little Rock, AR 72227-2306

Mailing address

PO Box 15538
Little Rock, AR 72231-5538

Other names 1

  • Blue Rose Physical Therapy - West Little Rock Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241218001813 AR Part B Supplier - Physical/Occupational Therapy Group in Private Practice 8022545862 Receives reassigned benefits from 4 practitioners
Practice locations: Little Rock, AR

National Provider Directory

National Provider Directory

Locations

1 Huntington Rd
Little Rock, AR 72227
Phone (501) 904-2778

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1729123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730937600000",
    "number": "1003636630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 15538",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722315538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 HUNTINGTON RD",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722272306",
            "telephone_number": "501-904-2778",
            "fax_number": "866-724-7887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE ROSE PHYSICAL THERAPY - WEST LITTLE ROCK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-17",
        "last_updated": "2024-11-07",
        "certification_date": "2024-11-07",
        "status": "A",
        "authorized_official_last_name": "DOCKERY",
        "authorized_official_first_name": "LOGAN",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "501-802-2844",
        "authorized_official_credential": "DR"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blue Rose Physical Therapy - West Little Rock",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Little Rock, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.