Provider Demographics
NPI:1053695551
Name:IVY PHYSICAL THERAPY, INC
Entity type:Organization
Organization Name:IVY PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:L
Authorized Official - Last Name:IVY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:501-206-7623
Mailing Address - Street 1:1100 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HEBER SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72543-2818
Mailing Address - Country:US
Mailing Address - Phone:501-206-7623
Mailing Address - Fax:501-362-8119
Practice Address - Street 1:1100 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HEBER SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72543-2818
Practice Address - Country:US
Practice Address - Phone:501-206-7623
Practice Address - Fax:501-362-8119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT3072261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy