Provider Demographics
NPI:1497300073
Name:PRO ACTIVE REHAB, INC
Entity type:Organization
Organization Name:PRO ACTIVE REHAB, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAWNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWHON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-776-1885
Mailing Address - Street 1:PO BOX 1890
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72018-1890
Mailing Address - Country:US
Mailing Address - Phone:501-776-1885
Mailing Address - Fax:501-776-1875
Practice Address - Street 1:1210 N ROCK ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:AR
Practice Address - Zip Code:72150-7761
Practice Address - Country:US
Practice Address - Phone:870-942-0760
Practice Address - Fax:870-942-0783
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRO ACTIVE REHAB, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-09
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty