Provider Demographics
NPI:1700049855
Name:BOBO, JAMIE L (PTA)
Entity Type:Individual
Prefix:MISS
First Name:JAMIE
Middle Name:L
Last Name:BOBO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 N HERVEY ST
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:AR
Mailing Address - Zip Code:71801-3435
Mailing Address - Country:US
Mailing Address - Phone:870-777-6798
Mailing Address - Fax:870-777-6880
Practice Address - Street 1:501 N HERVEY ST
Practice Address - Street 2:
Practice Address - City:HOPE
Practice Address - State:AR
Practice Address - Zip Code:71801-3435
Practice Address - Country:US
Practice Address - Phone:870-777-6798
Practice Address - Fax:870-777-6880
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA2255225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant