Provider Demographics
NPI:1033430483
Name:BARTUSEK, EVAN JAY (MS, ATC)
Entity Type:Individual
Prefix:MR
First Name:EVAN
Middle Name:JAY
Last Name:BARTUSEK
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTE
Mailing Address - State:IA
Mailing Address - Zip Code:52142-9206
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:605 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:IA
Practice Address - Zip Code:52142-9206
Practice Address - Country:US
Practice Address - Phone:563-425-5664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0006572255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer