Bryan Hathcock, PTA
Individual provider Active NPI Physical Therapy Assistant · Alton, MO
NPI 1689201105 · NPPES record last updated Mar 25, 2020
Key facts
- NPI
- 1689201105
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- 2018026101 (MO)
- Practice address
- 100 Medical Dr.
Alton, MO 65606 - Phone
- (417) 778-7227
- Fax
- (417) 778-7225
- NPI assigned
- Mar 25, 2020
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2018026101 | MO | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ozarks Medical Center | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 2018026101 | MO | Yes |
Addresses
Primary practice location
100 Medical Dr.
Alton, MO 65606
Mailing address
100 Medical Dr.
Alton, MO 65606
Phone (417) 778-7227
Other providers in Alton, MO
- Carol Colley
- David Combs
- County of Oregon
- Focus One Residential Services
- Glennette Haney
- Karen J Hollis
- Helen Kayleen King
- Alex Mills
- Myers Pharmacy
- Myers Pharmacy,Inc
All providers in Alton, MO · Physical Therapy Assistant in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 25, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.