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General NPI Number Information
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NPI Number | 1770392375
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Entity Type | Organization
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Legal Business Name | SHINE THERAPY INC.
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Dates
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Enumeration Date | 01/07/2025
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 13131 HIGHWAY 84
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City | BISMARCK
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State | AR
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Zip | 71929-6406
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Country | US
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Telephone | 870-464-7474
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Fax |
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Provider Business Mailing Address
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Address Line | 13131 HIGHWAY 84
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City | BISMARCK
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State | AR
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Zip | 71929-6406
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Country | US
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Telephone | 870-464-7474
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | REAGAN HARDAGE
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Credential | MS, OTR/L
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Telephone | 870-464-7474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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