Provider Demographics
NPI:1164911269
Name:REEP, ALLIE SWAYDE
Entity Type:Individual
Prefix:
First Name:ALLIE
Middle Name:SWAYDE
Last Name:REEP
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 1:389 BRADLEY ROAD 48
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:AR
Mailing Address - Zip Code:71647-9264
Mailing Address - Country:US
Mailing Address - Phone:870-820-9920
Mailing Address - Fax:
Practice Address - Street 1:389 BRADLEY ROAD 48
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:AR
Practice Address - Zip Code:71647-9264
Practice Address - Country:US
Practice Address - Phone:870-820-9920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2255A2300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer