Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner | AT171 | AR |
NPI | 1053798116 |
---|---|
Provider Name | Mr. Ronnie Harlow |
First Address | Searcy, AR 72149-0002 |
Second Address | Searcy, AR 72143 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2015 |
Last Update Date | 28/04/2015 |