Provider Demographics
NPI:1790163426
Name:NEYHART, LARRY GLENN JR (HIS)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:GLENN
Last Name:NEYHART
Suffix:JR
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43566-1161
Mailing Address - Country:US
Mailing Address - Phone:602-339-3766
Mailing Address - Fax:
Practice Address - Street 1:513 CEDAR LN
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43566-1161
Practice Address - Country:US
Practice Address - Phone:602-339-3766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-14
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501004763237700000X
OH2319237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist