Individual
MR. JOE IRVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1441 HIGHWAY 62 412, HIGHLAND, AR 72542-9497
(870) 856-9675
(870) 856-9679
Mailing address
1441 HIGHWAY 62 412, HIGHLAND, AR 72542-9497
(870) 856-9675
(870) 856-9679
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
PTA 2000
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PTA 2000
LICENSE
AR
Enumeration date
03/19/2007
Last updated
07/08/2007
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