NPIMap

Organization Active NPI

Pro-Active Rehab Inc.

Doing business as Malvern Physical Therapy & Wellness

  • Physical Therapist
  • Malvern, AR
National Provider Identifier
1285878991
Registry record updated Apr 24, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT1316 Issued in AR
Legal business name
PRO-ACTIVE REHAB INC.
Doing business as
Malvern Physical Therapy & Wellness
Practice address
720 Walco Rd
Suite 240
Malvern, AR 72104
Phone
(501) 467-8275
Fax
(501) 467-8145
NPI assigned
Apr 24, 2009
Last updated
Apr 24, 2009By the provider in NPPES
Organization subpart
Yes
Parent organization
PRO-ACTIVE REHAB INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 24, 2009

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

Authorized official

Name
James R Lee, P.T.NPI 1629082805
Title
Owner
Phone
(501) 778-4960

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT1316 AR Primary

Addresses

Primary practice location

720 Walco Rd
Suite 240
Malvern, AR 72104

Mailing address

P.O. Box 1890
Benton, AR 72018
Phone (501) 778-4960

Other names 1

  • Malvern Physical Therapy & Wellness Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Malvern Physical Therapy and Wellness5 organizations share this tax ID, including this one
Part of
Malvern Physical Therapy and Wellness

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1240531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1240531200000",
    "number": "1285878991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 1890",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "72018",
            "telephone_number": "501-778-4960",
            "fax_number": "501-778-4968"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 WALCO RD",
            "address_2": "SUITE 240",
            "city": "MALVERN",
            "state": "AR",
            "postal_code": "72104",
            "telephone_number": "501-467-8275",
            "fax_number": "501-467-8145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRO-ACTIVE REHAB INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRO-ACTIVE REHAB INC.",
        "enumeration_date": "2009-04-24",
        "last_updated": "2009-04-24",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "501-778-4960",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AR",
            "license": "PT1316",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Malvern Physical Therapy & Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Malvern, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2009; 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.