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General NPI Number Information
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NPI Number | 1871398057
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Entity Type | Individual
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Provider Name | STORMI LYNN HARRISON
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Gender | Female
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Dates
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Enumeration Date | 02/13/2025
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 3333 S PINNACLE HILLS PKWY
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City | ROGERS
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State | AR
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Zip | 72758-9100
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Country | US
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Telephone | 479-464-4413
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Fax |
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Provider Business Mailing Address
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Address Line | 21508 STONE RD
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City | SPRINGDALE
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State | AR
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Zip | 72764-8803
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Country | US
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Telephone | 479-225-1431
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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 | 1616520
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License Number State | AR
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