Provider Demographics
NPI:1629128251
Name:BATTE, JIMMY L (PTA)
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:L
Last Name:BATTE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:943 PINE LOG RD.
Mailing Address - Street 2:
Mailing Address - City:WARRENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29851
Mailing Address - Country:US
Mailing Address - Phone:803-649-9797
Mailing Address - Fax:
Practice Address - Street 1:943 PINE LOG RD
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-7330
Practice Address - Country:US
Practice Address - Phone:803-649-9797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2068174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2068OtherSTATE LICENSE