Michael Bryan Paddock, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA1472

Practice address

92 Quapaw TRL
Jacksonville, AR 72076-8991

Phone

(501) 626-5825

NPI assigned

Apr 30, 2012

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1335744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1335744000000",
    "number": "1417215203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "92 QUAPAW TRL",
            "city": "JACKSONVILLE",
            "state": "AR",
            "postal_code": "720768991",
            "telephone_number": "501-626-5825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "92 QUAPAW TRL",
            "city": "JACKSONVILLE",
            "state": "AR",
            "postal_code": "720768991",
            "telephone_number": "501-626-5825"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PADDOCK",
        "first_name": "MICHAEL",
        "middle_name": "BRYAN",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-04-30",
        "last_updated": "2012-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": null,
            "license": "PTA1472",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrew George Orr, D.D.S.
• Raymond Charles Ortega, LPC
• Shannon Marie Overcash, LAC, LAMFT
• Baylee Pack, QBHP
• George O. Paddock, M.D.
• Jerry B Park, OP
• Randy Joseph Pastor, DO
• Chandani Umang Patel, PHARM. D.
• Urvi R Patel
• Pathfinder, Inc

• Physical Therapy Assistant in Jacksonville, AR
• Providers in Jacksonville, AR by specialty
• Physical Therapy Assistant in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.