Provider Demographics
NPI:1407919590
Name:BATES, THOMAS P (PT,MS,CERT MDT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:P
Last Name:BATES
Suffix:
Gender:M
Credentials:PT,MS,CERT MDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 ALDERSGATE RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6613
Mailing Address - Country:US
Mailing Address - Phone:501-796-3240
Mailing Address - Fax:501-796-3242
Practice Address - Street 1:1601 ALDERSGATE RD
Practice Address - Street 2:SUITE D-4
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6613
Practice Address - Country:US
Practice Address - Phone:501-687-0851
Practice Address - Fax:501-687-0853
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2450225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR156654721Medicaid
AR5X452OtherBLUE CROSS
AR5X452OtherBLUE CROSS
AR5W1545C883Medicare ID - Type UnspecifiedMEDICARE