Healthcare Provider Details

I. General information

NPI: 1417812561
Provider Name (Legal Business Name): LOUISVILLE REUBEN MARVIN HARPER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2025
Last Update Date: 12/22/2025
Certification Date: 12/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3631 DECOURSEY AVE
COVINGTON KY
41015-1436
US

IV. Provider business mailing address

209 W 18TH ST FL 2
COVINGTON KY
41011-2959
US

V. Phone/Fax

Practice location:
  • Phone: 859-431-2273
  • Fax:
Mailing address:
  • Phone: 513-372-4423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number281115
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: