Pro Active Rehab, Inc
Organization Active NPI Physical Therapist · Bryant, AR
NPI 1255829404 · NPPES record last updated Jul 1, 2019
Key facts
- NPI
- 1255829404
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapist 225100000X
- Legal business name
- PRO ACTIVE REHAB, INC
- Practice address
- 5309 Highway 5 N Ste 150
Bryant, AR 72022-9259 - Phone
- (501) 847-3320
- Fax
- (501) 847-3381
- NPI assigned
- Apr 24, 2018
- Organization subpart
- No
Authorized official
- Name
- Rodney Joel Rhodes
- Title
- Manager
- Phone
- (501) 776-1885
Other NPIs on the same Medicare enrollment 5
Corporate family (same tax ID) 4
Practitioners 1
-
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 This NPI is an additional NPI on the enrollment Practice locations: Bryant, AR; Sheridan, AR; Benton, AR; Malvern, AR |
National Provider Directory
- Tax ID family
- Malvern Physical Therapy and Wellness
Locations
5309 Highway 5 N
Ste 150
Bryant, AR 72022
Phone (501) 847-3320
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist |
225100000X | Yes |
Addresses
Primary practice location
5309 Highway 5 N Ste 150
Bryant, AR 72022-9259
Mailing address
PO Box 1890
Benton, AR 72018-1890
Phone (501) 776-1885
Other names
- Pro-Active Physical Therapy Bryant
NPI Registry JSON
{
"created_epoch": "1524528000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1561939200000",
"number": "1255829404",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1890",
"city": "BENTON",
"state": "AR",
"postal_code": "720181890",
"telephone_number": "501-776-1885",
"fax_number": "501-776-1875"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5309 HIGHWAY 5 N STE 150",
"city": "BRYANT",
"state": "AR",
"postal_code": "720229259",
"telephone_number": "501-847-3320",
"fax_number": "501-847-3381"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PRO ACTIVE REHAB, INC",
"organizational_subpart": "NO",
"enumeration_date": "2018-04-24",
"last_updated": "2019-07-01",
"status": "A",
"authorized_official_last_name": "RHODES",
"authorized_official_first_name": "RODNEY",
"authorized_official_middle_name": "JOEL",
"authorized_official_title_or_position": "MANAGER",
"authorized_official_telephone_number": "501-776-1885"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Physical Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Pro-Active Physical Therapy Bryant",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Bryant, AR
- Samantha Pratt
- Premiere Medical Supply, Inc.
- Jenna Preston
- Lauren Nicole Price
- Prime Anesthesia PLLC
- Jordan Profit
- Elyssa Propst
- PTMD Consultants PLLC
- PTMD Consultants, PLLC
- Desiree Purifoy
All providers in Bryant, 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 Jul 1, 2019. 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.