Provider Demographics
NPI:1881806404
Name:BATES, JOHN T (MPT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:BATES
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 S 5TH AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-6410
Mailing Address - Country:US
Mailing Address - Phone:208-232-4267
Mailing Address - Fax:208-232-4268
Practice Address - Street 1:275 S 5TH AVE STE 140
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-6410
Practice Address - Country:US
Practice Address - Phone:208-232-4267
Practice Address - Fax:208-232-4268
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-1730225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1654575Medicare ID - Type Unspecified