Provider Demographics
NPI:1255497624
Name:CATES, JASON MAURICE (ATC)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:MAURICE
Last Name:CATES
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 1:28 EMERALD CIR
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-8176
Mailing Address - Country:US
Mailing Address - Phone:501-920-2998
Mailing Address - Fax:
Practice Address - Street 1:401 N LINCOLN ST
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-2625
Practice Address - Country:US
Practice Address - Phone:501-743-3541
Practice Address - Fax:501-941-2438
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1822255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR22Medicare UPIN