Provider Demographics
NPI:1831502517
Name:FLUHARTY, JACK LEE JR (MS, LATC)
Entity Type:Individual
Prefix:MR
First Name:JACK
Middle Name:LEE
Last Name:FLUHARTY
Suffix:JR
Gender:M
Credentials:MS, LATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1498 STATE ROUTE 213
Mailing Address - Street 2:
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952
Mailing Address - Country:US
Mailing Address - Phone:740-284-8721
Mailing Address - Fax:
Practice Address - Street 1:1498 STATE ROUTE 213
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952
Practice Address - Country:US
Practice Address - Phone:740-284-8721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH942310171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor