NPIMap

Organization Active NPI

Pro Active Rehab, Inc

  • Physical Therapist
  • Sheridan, AR
National Provider Identifier
1497300073
Registry record updated Aug 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
PRO ACTIVE REHAB, INC
Practice address
1210 N Rock St
Sheridan, AR 72150-7761
Phone
(870) 942-0760
Fax
(870) 942-0783
NPI assigned
Aug 9, 2019
Organization subpart
Yes
Parent organization
PRO ACTIVE REHAB, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 9, 2019

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

Authorized official

Name
Shawna Lawhon
Title
Admin Director
Phone
(501) 776-1885

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

1210 N Rock St
Sheridan, AR 72150-7761

Mailing address

PO Box 1890
Benton, AR 72018-1890
Phone (501) 776-1885

Other names 1

  • Pro-Active Physical Therapy Sheridan 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.

Locations

620 W 3rd St
Ste 303
Little Rock, AR 72201
Phone (501) 372-9100

1210 N Rock St
Sheridan, AR 72150
Phone (870) 942-0760

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1565308800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565308800000",
    "number": "1497300073",
    "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": "1210 N ROCK ST",
            "city": "SHERIDAN",
            "state": "AR",
            "postal_code": "721507761",
            "telephone_number": "870-942-0760",
            "fax_number": "870-942-0783"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRO ACTIVE REHAB, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRO ACTIVE REHAB, INC",
        "enumeration_date": "2019-08-09",
        "last_updated": "2019-08-09",
        "status": "A",
        "authorized_official_last_name": "LAWHON",
        "authorized_official_first_name": "SHAWNA",
        "authorized_official_title_or_position": "ADMIN DIRECTOR",
        "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 Sheridan",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sheridan, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2019; 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.