IDUMANGE T. IDUMANGE (PT) – Physical Therapist, NPI 1083864649
Physical Therapist
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
835 PHYSICAL THERAPIST IN PRIVATE PRACTICE in AR
Provider Addresses for IDUMANGE T. IDUMANGE (PT)
505 W PERSHING BLVD STE D
N LITTLE ROCK, AR 721142157
Phone: (501) 812-4970
Fax: (501) 812-4972
Type: Location
Eldridge Avenue East, Wynne, Cross County, Arkansas, 72396, United States
WYNNE, AR 723964032
Phone: (870) 208-8989
Fax: (870) 208-8107
Type: Mailing
PO BOX 9178
RUSSELLVILLE, AR 728119178
Phone: (008) 824-4094
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2024-12-02
PECOS data refreshed: 2026-06-15
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20241202000189 | I | Physical Therapist In Private Practice | AR | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 72114)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Physical Therapist In Private Practice | AR | |
| - | AR | |
| - | AR | |
| Physical Therapist In Private Practice | AR | |
| - | AR | |
| Physical Therapist In Private Practice | AR |
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