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General NPI Number Information
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NPI Number | 1619337904
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Entity Type | Organization
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Legal Business Name | HORSE-PLAY PEDIATRICS
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Dates
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Enumeration Date | 02/29/2016
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Last Update Date | 02/29/2016
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Provider Practice Location Address
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Address Line | 3801 JOHNSON MILL BLVD STE B
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City | FAYETTEVILLE
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State | AR
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Zip | 72704-6364
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Country | US
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Telephone | 479-856-6400
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Fax |
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Provider Business Mailing Address
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Address Line | 3801 JOHNSON MILL BLVD STE B
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City | FAYETTEVILLE
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State | AR
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Zip | 72704-6364
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Country | US
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Telephone | 479-856-6400
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | EMILY ROBERTS
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Credential |
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Telephone | 479-856-6400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number | PT3719
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License Number State | AR
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