1649622580 NPI number — BRIXEY THERAPY SERVICES

Table of content: (NPI 1972109015)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649622580 NPI number — BRIXEY THERAPY SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRIXEY THERAPY SERVICES
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:
1649622580
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/03/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6104 CEDAR BREAK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT SMITH
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72916-9109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-650-7389
Provider Business Mailing Address Fax Number:
479-928-5055

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6301 HIGHWAY 45
Provider Second Line Business Practice Location Address:
SUITE H
Provider Business Practice Location Address City Name:
FORT SMITH
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72916-8851
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-650-7389
Provider Business Practice Location Address Fax Number:
479-928-5055
Provider Enumeration Date:
07/03/2016

Additional Information

Authorized Official

Authorized Official Last Name:
BRIXEY
Authorized Official First Name:
LESLIE
Authorized Official Middle Name:
FONTAINE
Authorized Official Title or Position:
SPEECH-LANGUAGE PATHOLOGIST
Authorized Official Telephone Number:
479-650-7389

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  2078 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 15480721 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com