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General NPI Number Information
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NPI Number | 1144627399
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Entity Type | Individual
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Provider Name | GLEN FLEMING LMT, M.M.P
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Gender | Male
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Dates
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Enumeration Date | 12/03/2014
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 117 W CHAMPIONS BLVD STE 16
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City | ROGERS
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State | AR
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Zip | 72758-9562
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Country | US
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Telephone | 479-685-7788
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Fax |
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Provider Business Mailing Address
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Address Line | 117 W CHAMPIONS BLVD STE 16
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City | ROGERS
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State | AR
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Zip | 72758-9562
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Country | US
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Telephone | 479-685-7788
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 8483
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License Number State | AR
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