Healthcare Provider Details

I. General information

NPI: 1174451157
Provider Name (Legal Business Name): ANTHONY HAFNER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 W GROVE AVE
SPRINGDALE AR
72764-4435
US

IV. Provider business mailing address

619 W GROVE AVE
SPRINGDALE AR
72764-4435
US

V. Phone/Fax

Practice location:
  • Phone: 870-416-5114
  • Fax:
Mailing address:
  • Phone: 870-416-5114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number1617797
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: