MEDICARE: MR. THOMAS ANTHONY BARTOLE P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1796	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5Y916	OTHER	AR	BLUE CROSS/BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538111612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS ANTHONY BARTOLE P.T.

Provider Business Mailing Address
First Line	:	141 CASTLE HEIGHTS DR
Second Line	:
City	:	CABOT
State	:	AR
Zip	:	72023-8330
Country	:	US
Telephone Number	:	501-941-3471
Fax Number	:	501-982-0592

Provider Business Practice Location Address
First Line	:	1200 W MAIN ST
Second Line	:
City	:	JACKSONVILLE
State	:	AR
Zip	:	72076-4348
Country	:	US
Telephone Number	:	501-982-0591
Fax Number	:	501-982-0592

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	09/15/2008

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Directions to “ MR. THOMAS ANTHONY BARTOLE P.T.” Practice Location

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