Provider Demographics
NPI:1619328366
Name:LONG, ROBERT STEVEN (MS, ATC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:STEVEN
Last Name:LONG
Suffix:
Gender:M
Credentials:MS, ATC
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Mailing Address - Street 1:6401 S HAZEL ST APT 110
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-7842
Mailing Address - Country:US
Mailing Address - Phone:662-897-4314
Mailing Address - Fax:870-575-4655
Practice Address - Street 1:1200 UNIVERSITY DR
Practice Address - Street 2:4891
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71601-2780
Practice Address - Country:US
Practice Address - Phone:870-575-7230
Practice Address - Fax:870-575-4655
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARAT 6722255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer