Pro Active Rehab, Inc
Organization Active NPI Physical Therapist · Benton, AR
NPI 1215021159 · NPPES record last updated Dec 5, 2011
Key facts
- NPI
- 1215021159
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapist 225100000X
- License
- PT 842 (AR)
- Legal business name
- PRO ACTIVE REHAB, INC
- Practice address
- 1308 Military Rd
Benton, AR 72015-2911 - Phone
- (501) 778-4960
- Fax
- (501) 778-4968
- NPI assigned
- Oct 3, 2006
- Organization subpart
- No
Authorized official
- Name
- Dan B Myers, PT
- Title
- President
- Phone
- (501) 778-4960
Other NPIs on the same Medicare enrollment 5
Corporate family (same tax ID) 4
Practitioners 17
-
Krista Janai Adams, DPT, PT
-
Nicholas Dobbs, PT, DPT
-
Michael Lewis Johnson, MSPT
-
Daniel B. Myers Jr., PHYSICAL THERAPIST
-
Macy Purifoy, PT
-
Robert Roberson, DPT
-
Mackenzie Simon, PT
-
Bradley Vandivere, DPT
-
Gwyn Anne Arnold, PT
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060425000699 | AR | Part B Supplier - Physical/Occupational Therapy Group in Private Practice | 2668482340 |
Receives reassigned benefits from 15 practitioners 5 other NPIs on this enrollment Practice locations: Bryant, AR; Sheridan, AR; Benton, AR; Malvern, AR |
National Provider Directory
- Tax ID family
- Malvern Physical Therapy and Wellness
Locations
1301 Hwy 270 Ste 104
Malvern, AR 72104
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist |
225100000X | PT 842 | AR | Yes |
Addresses
Primary practice location
1308 Military Rd
Benton, AR 72015-2911
Mailing address
PO Box 1890
Benton, AR 72018-1890
Phone (501) 778-4960
Other providers in Benton, AR
- Stacy Price
- Teresa Price
- Autumn P Pride
- Prime Medical Group PLLC
- Laura Prince
- Promed Preferred Ar 2 Professional Corporation
- Keith Propps
- Prospective Health LTD
- Erica Lynn Pruitt
- Matthew H Pruitt
All providers in Benton, AR · Physical Therapist in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 5, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.