Kings River Physical Therapy Inc

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

PT2047 Issued in AR

Legal business name

KINGS RIVER PHYSICAL THERAPY INC

Practice address

402 W College Ave.
Berryville, AR 72616-3142

Phone

(870) 423-3316

Fax

(870) 423-3177

NPI assigned

May 30, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Gary Wade Hill, RPTNPI 1235119694

Title

President

Phone

(870) 423-3316

Specialties & licenses 1

Addresses

Other identifiers 2

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.

• Gary Wade Hill, P.T.

  • Physical Therapist
  • Berryville, AR
  • NPI 1235119694
  Medicare reassignment Authorized official
• Allison Paige Hudgens, DPT

  • Physical Therapist
  • Berryville, AR
  • NPI 1265108435
  Medicare reassignment NPD

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

{
    "created_epoch": "1180483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1367798400000",
    "number": "1245431964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "402 W COLLEGE AVE.",
            "city": "BERRYVILLE",
            "state": "AR",
            "postal_code": "726163142",
            "telephone_number": "870-423-3316",
            "fax_number": "870-423-3177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 W COLLEGE AVE.",
            "city": "BERRYVILLE",
            "state": "AR",
            "postal_code": "726163142",
            "telephone_number": "870-423-3316",
            "fax_number": "870-423-3177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KINGS RIVER PHYSICAL THERAPY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-30",
        "last_updated": "2013-05-06",
        "status": "A",
        "authorized_official_last_name": "HILL",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "WADE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "870-423-3316",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "AR",
            "license": "PT2047",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "154777742",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP",
            "identifier": "5Y014",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joseph M. Ricciardi, M.D.
• Joseph M. Ricciardi, M.D.
• Emily Keith
• Grace Kennedy, SLP
• Kingdom Harvest Ministries, Inc
• Kim Arehart Knapp, MHPP
• McKenzie Koch, PHARMD
• Bissett Krawczyk, COTA/L
• Candice Lacey, PTA
• Jennifer Lampe

• Physical Therapy Clinic/Center in Berryville, AR
• Providers in Berryville, AR by specialty
• Physical Therapy Clinic/Center in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2013; 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.