Provider Demographics
NPI:1114026986
Name:BARTLEY, DYLAN FRANCIS (MSPT)
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:FRANCIS
Last Name:BARTLEY
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1179 N MCDOWELL BLVD
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-6559
Mailing Address - Country:US
Mailing Address - Phone:707-559-7500
Mailing Address - Fax:707-559-7620
Practice Address - Street 1:580 MARKET ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104
Practice Address - Country:US
Practice Address - Phone:415-788-2100
Practice Address - Fax:415-788-2102
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28896225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ26424ZMedicare ID - Type Unspecified