Provider Demographics
NPI:1174966469
Name:PEDIATRIC THERAPY SOLUTIONS LLC
Entity type:Organization
Organization Name:PEDIATRIC THERAPY SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHAMBLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:WITHERSPOON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:870-636-7571
Mailing Address - Street 1:1217 LAYMAN DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-9143
Mailing Address - Country:US
Mailing Address - Phone:870-636-7571
Mailing Address - Fax:870-934-1270
Practice Address - Street 1:1217 LAYMAN DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-9143
Practice Address - Country:US
Practice Address - Phone:870-636-7571
Practice Address - Fax:870-934-1270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-17
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR2366225X00000X
ARPT2766225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty