Basic Information
| Provider Information | |||||||||
| NPI: | 1578737623 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BITTLE | ||||||||
| FirstName: | JASON | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3090 WOODRUFF CREEK DR | ||||||||
| Address2: | |||||||||
| City: | SHERWOOD | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721202686 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5014143930 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2323 MCCAIN BLVD | ||||||||
| Address2: | |||||||||
| City: | NORTH LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721167519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5017912323 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2008 | ||||||||
| LastUpdateDate: | 06/07/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 3178 | NC | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | 225200000X | 2258 | AR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.