Custom Care Therapy Corp.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1583 Issued in AR

Legal business name

CUSTOM CARE THERAPY CORP.

Practice address

4600 Edgemere St
N Little Rock, AR 72116-7424

Phone

(501) 812-6451

Fax

(501) 812-6451

NPI assigned

Apr 3, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Samuel Cole Chaffin, MSPT

Title

Physical Therapist

Phone

(501) 812-6451

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1598886798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4600 EDGEMERE ST",
            "city": "N LITTLE ROCK",
            "state": "AR",
            "postal_code": "721167424",
            "telephone_number": "501-812-6451",
            "fax_number": "501-812-6451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4600 EDGEMERE ST",
            "city": "N LITTLE ROCK",
            "state": "AR",
            "postal_code": "721167424",
            "telephone_number": "501-812-6451",
            "fax_number": "501-812-6451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUSTOM CARE THERAPY CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CHAFFIN",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "COLE",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "501-812-6451",
        "authorized_official_credential": "MSPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AR",
            "license": "1583",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "5T405",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dane Paul Clement, LCSW
• Andrew B Conover
• Contact Lens & Vision Care Associates PA
• Ravaina Lynn Copeland
• Cornerstone Pharmacy JFK LLC
• Karen T Dang, PHARMD
• Davids Pharmacy Inc (Medicine Shoppe)
• Dr. Don M. Whitten Dentistry PA (North Hills Family Dental)
• Dr. Jerry L. Shue
• Judye Ann Ebanks, LMSW

• Physical Therapist in N Little Rock, AR
• Providers in N Little Rock, AR by specialty
• Physical Therapist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.