Individual
MR. NOBLE BLAKE MCBRIDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
978 COLEY DR, MOUNTAIN HOME, AR 72653
(870) 425-5881
(870) 425-5966
Mailing address
PO BOX 1507, MOUNTAIN HOME, AR 72654-1507
(870) 425-5881
(870) 425-5966
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT 1458
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5T741
BC BS PROVIDER NUMBER
AR
Enumeration date
11/27/2006
Last updated
07/08/2007
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