| |
5552 Us Hwy 63, Suite B, Imboden, AR 72434 | |
(870) 869-2770 | |
(870) 869-7221 |
Full Name | |
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Type | Facility |
Speciality | Clinic/center - Physical Therapy |
Location | 5552 Us Hwy 63, Imboden, Arkansas |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1679071302 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
225100000X | Physical Therapist | PT2712 (Arkansas) | Secondary |
261QP2000X | Clinic/center - Physical Therapy | PT2712 (Arkansas) | Primary |
Provider Name | Bryan R Declerk |
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Provider Type | Practitioner - Physical Therapist In Private Practice |
Provider Identifiers | NPI Number: 1558806299 PECOS PAC ID: 1456637446 Enrollment ID: I20170803001435 |
Provider Name | Holli Dawn Lillard |
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Provider Type | Practitioner - Physical Therapist In Private Practice |
Provider Identifiers | NPI Number: 1134639222 PECOS PAC ID: 5890051304 Enrollment ID: I20171115002394 |
Mailing Address | Practice Location Address |
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Po Box 334, Imboden, AR 72434-0334 Ph: (870) 869-2770 | 5552 Us Hwy 63, Suite B, Imboden, AR 72434 Ph: (870) 869-2770 |