MEDICARE: GAYLE QUATTLEBAUM 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	PT497	AR

General Provider Information

NPI Number	:	1790727105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAYLE QUATTLEBAUM P.T.

Provider Business Mailing Address
First Line	:	501 JACKSON STEPHENS DRIVE UAMS MAILBOX #626
Second Line	:	UNIVERSITY REHAB, GROUND FLOOR
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-7199
Country	:	US
Telephone Number	:	501-661-7955
Fax Number	:	501-661-7961

Provider Business Practice Location Address
First Line	:	501 JACKSON STEPHENS DRIVE
Second Line	:	UAMS-UNIVERSITY REHAB, GROUND FLOOR
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-7199
Country	:	US
Telephone Number	:	501-227-9920
Fax Number	:	501-227-5223

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

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	09/19/2013

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