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General NPI Number Information
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NPI Number | 1699295055
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Entity Type | Organization
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Legal Business Name | HARGIS PEDIATRIC THERAPY, L.L.C
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Dates
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Enumeration Date | 06/26/2017
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Last Update Date | 06/26/2017
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Provider Practice Location Address
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Address Line | 815 N GASKILL ST
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City | HUNTSVILLE
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State | AR
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Zip | 72740-8968
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Country | US
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Telephone | 903-277-8039
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Fax | 479-738-2070
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Provider Business Mailing Address
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Address Line | 558 MADISON 8593
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City | HUNTSVILLE
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State | AR
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Zip | 72740-9326
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Country | US
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Telephone | 903-277-8039
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Fax | 479-738-2070
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Authorized Official
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Title or Position | OWNER/SLP
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Name | JORDAN R HARGIS
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Credential | SLP
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Telephone | 903-277-8039
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number | 3333
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License Number State | AR
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