Provider Demographics
NPI:1225500499
Name:LEAVY, SPURGEON (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:SPURGEON
Middle Name:
Last Name:LEAVY
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14600 HINSON RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-2528
Mailing Address - Country:US
Mailing Address - Phone:501-960-6243
Mailing Address - Fax:
Practice Address - Street 1:10515 W MARKHAM ST STE F3
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-2291
Practice Address - Country:US
Practice Address - Phone:501-310-0020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-27
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR7230225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty