Provider Demographics
NPI:1538111612
Name:BARTOLE, THOMAS ANTHONY (PT)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:ANTHONY
Last Name:BARTOLE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 CASTLE HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-8330
Mailing Address - Country:US
Mailing Address - Phone:501-941-3471
Mailing Address - Fax:501-982-0592
Practice Address - Street 1:1200 W MAIN ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-4348
Practice Address - Country:US
Practice Address - Phone:501-982-0591
Practice Address - Fax:501-982-0592
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1796225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5Y916OtherBLUE CROSS/BLUE SHIELD
AR161147721Medicaid
AR5733900001Medicare NSC
AR5Y916OtherBLUE CROSS/BLUE SHIELD