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General NPI Number Information
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NPI Number | 1598589475
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Entity Type | Individual
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Provider Name | ROBERT AARON LEAGUE
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Gender | Male
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Dates
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Enumeration Date | 11/08/2024
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Last Update Date | 12/05/2024
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Provider Practice Location Address
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Address Line | 1699 RED WOLF BLVD
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City | JONESBORO
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State | AR
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Zip | 72401-5442
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Country | US
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Telephone | 870-336-0021
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Fax |
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Provider Business Mailing Address
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Address Line | 104 WALNUT ST
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City | BROOKLAND
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State | AR
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Zip | 72417-8841
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Country | US
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Telephone | 870-530-9376
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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 | 2081P0010X
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Taxonomy Name | Pediatric Rehabilitation Medicine Physician
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License Number | 4977
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License Number State | AR
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