Provider Demographics
NPI:1083978191
Name:HARGRAVES, ARNAE
Entity Type:Individual
Prefix:MS
First Name:ARNAE
Middle Name:
Last Name:HARGRAVES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 BLACKSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:SUFFL
Mailing Address - State:VIRGINIA
Mailing Address - Zip Code:23435
Mailing Address - Country:UM
Mailing Address - Phone:757-754-9674
Mailing Address - Fax:
Practice Address - Street 1:2708 NE 14TH ST
Practice Address - Street 2:SUITE 5
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-3565
Practice Address - Country:US
Practice Address - Phone:888-880-9270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-03
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist