Active NPI
Eleasah McNabb
- Physical Therapist
- Russellville, AR
National Provider Identifier
1205954088
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT 2769
- Practice address
- 1301 Russell Road
Russellville, AR 72801 - Phone
- (479) 967-2322
- Fax
- (479) 967-2876
- NPI assigned
- Mar 27, 2007
- Last updated
- Apr 9, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT 2769 | AR | Primary |
Addresses
Primary practice location
1301 Russell Road
Russellville, AR 72801
Mailing address
PO Drawer 2109
Russellville, AR 72811
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 155115721 | Medicaid | AR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AR
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231013001460 | AR | Practitioner - Physical Therapist in Private Practice | 1557716313 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT 2769 | AR | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174953600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1333929600000",
"number": "1205954088",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO DRAWER 2109",
"city": "RUSSELLVILLE",
"state": "AR",
"postal_code": "72811"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1301 RUSSELL ROAD",
"city": "RUSSELLVILLE",
"state": "AR",
"postal_code": "72801",
"telephone_number": "479-967-2322",
"fax_number": "479-967-2876"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCNABB",
"first_name": "ELEASAH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-27",
"last_updated": "2012-04-09",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AR",
"license": "PT 2769",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "155115721",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Russellville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2012; 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.