Provider Demographics
NPI:1487939013
Name:REEVES, RICHARD ALLEN (MS, RCEP)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:ALLEN
Last Name:REEVES
Suffix:
Gender:M
Credentials:MS, RCEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 W GROVE ST
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-4416
Mailing Address - Country:US
Mailing Address - Phone:870-875-6201
Mailing Address - Fax:870-875-6239
Practice Address - Street 1:700 W GROVE ST
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4416
Practice Address - Country:US
Practice Address - Phone:870-875-6201
Practice Address - Fax:870-875-6239
Is Sole Proprietor?:No
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1010879224Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist