Source Therapy Solutions PLLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT3097 Issued in AR

Legal business name

SOURCE THERAPY SOLUTIONS PLLC

Practice address

1721 Martin Luther King Blvd
Suite I
Malvern, AR 72104-2085

Phone

(501) 249-5354

NPI assigned

Dec 14, 2012

Organization subpart

No

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

Authorized official

Name

Michael Robert Schoultz, PT, DPTNPI 1912143975

Title

Owner, Chief Manager, Therapist

Phone

(501) 249-5354

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael Robert Schoultz, PT, DPT

  • Physical Therapist
  • Malvner, AR
  • NPI 1912143975
  Medicare reassignment NPD Authorized official
• Carrie Anne Schoultz, LMT

  • Massage Therapist
  • Malvern, AR
  • NPI 1144560194
  NPD (past)

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

{
    "created_epoch": "1355443200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611532800000",
    "number": "1194061309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1721 MARTIN LUTHER KING BLVD",
            "address_2": "SUITE I",
            "city": "MALVERN",
            "state": "AR",
            "postal_code": "721042085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1721 MARTIN LUTHER KING BLVD",
            "address_2": "SUITE I",
            "city": "MALVERN",
            "state": "AR",
            "postal_code": "721042085",
            "telephone_number": "501-249-5354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOURCE THERAPY SOLUTIONS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-14",
        "last_updated": "2021-01-25",
        "certification_date": "2021-01-25",
        "status": "A",
        "authorized_official_last_name": "SCHOULTZ",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "OWNER, CHIEF MANAGER, THERAPIST",
        "authorized_official_telephone_number": "501-249-5354",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "AR",
            "license": "PT3097",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jordan Smith
• Nicole Smith, RN
• Rebecca Smith
• Sasha Smith, RECOVERY ADVOCATE
• Teresa Smith, MHPP
• Mellisa L Sparks, AT
• State of Arkansas
• Mandi Stidham, CMP
• Penny Stokes
• Cady Stone

• Physical Therapist in Malvern, AR
• Providers in Malvern, AR by specialty
• Physical Therapist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2021; 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.