Healthcare Provider Details

I. General information

NPI: 1700049855
Provider Name (Legal Business Name): JAMIE L BOBO PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 07/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N HERVEY ST
HOPE AR
71801-3435
US

IV. Provider business mailing address

501 N HERVEY ST
HOPE AR
71801-3435
US

V. Phone/Fax

Practice location:
  • Phone: 870-777-6798
  • Fax: 870-777-6880
Mailing address:
  • Phone: 870-777-6798
  • Fax: 870-777-6880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA2255
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: