Provider Demographics
NPI:1316266638
Name:BRYANT BETHEL PHYSICAL THERAPY PA
Entity type:Organization
Organization Name:BRYANT BETHEL PHYSICAL THERAPY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:GAISER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:501-847-0107
Mailing Address - Street 1:608 W COMMERCE DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-6202
Mailing Address - Country:US
Mailing Address - Phone:501-847-0107
Mailing Address - Fax:
Practice Address - Street 1:608 W COMMERCE DR
Practice Address - Street 2:SUITE 2
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-6202
Practice Address - Country:US
Practice Address - Phone:501-847-0107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-26
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT1009225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty