Provider Demographics
NPI:1710235080
Name:HUDDLESTON, SEAN ROSS (ATC)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:ROSS
Last Name:HUDDLESTON
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2858 W REDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-5139
Mailing Address - Country:US
Mailing Address - Phone:417-239-4242
Mailing Address - Fax:
Practice Address - Street 1:1350 S GUTENSOHN RD
Practice Address - Street 2:#10
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-5117
Practice Address - Country:US
Practice Address - Phone:479-751-7122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAT 5672255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer