Healthcare Provider Details

I. General information

NPI: 1518063304
Provider Name (Legal Business Name): STEVEN SETH HARRELL PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 12/16/2020
Certification Date: 12/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 HARKRIDER ST STE 6
CONWAY AR
72032-5690
US

IV. Provider business mailing address

1500 MUSEUM RD STE 104
CONWAY AR
72032-4761
US

V. Phone/Fax

Practice location:
  • Phone: 501-358-6170
  • Fax: 501-658-6190
Mailing address:
  • Phone: 501-329-3804
  • Fax: 501-329-0718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2761
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: