Provider Demographics
NPI:1164712725
Name:REAPER THERAPY, LLC
Entity Type:Organization
Organization Name:REAPER THERAPY, LLC
Other - Org Name:DELTIC THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LLC MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:K
Authorized Official - Last Name:COLLIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-347-2568
Mailing Address - Street 1:821 E PARK ST
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:AR
Mailing Address - Zip Code:72024-9024
Mailing Address - Country:US
Mailing Address - Phone:870-552-7110
Mailing Address - Fax:870-552-7115
Practice Address - Street 1:821 E PARK ST
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:AR
Practice Address - Zip Code:72024-9024
Practice Address - Country:US
Practice Address - Phone:870-552-7110
Practice Address - Fax:870-552-7115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-15
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR187687742Medicaid
AR187820742Medicaid