1427727569 NPI number — EMPOWERED THERAPY COLLECTIVE LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427727569 NPI number — EMPOWERED THERAPY COLLECTIVE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMPOWERED THERAPY COLLECTIVE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427727569
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1275 S JASMINE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72704-7708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-315-0715
Provider Business Mailing Address Fax Number:
479-308-0285

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1845 MAIN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72704-5220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-315-0715
Provider Business Practice Location Address Fax Number:
479-308-0285
Provider Enumeration Date:
09/11/2021

Additional Information

Authorized Official

Authorized Official Last Name:
TAYLOR
Authorized Official First Name:
TARYN
Authorized Official Middle Name:
Authorized Official Title or Position:
SPEECH LANGUAGE PATHOLOGIST, OWNER
Authorized Official Telephone Number:
479-315-0715

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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