Provider Demographics
NPI:1467535187
Name:BARTELS, LISA S (DPT, PRC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:S
Last Name:BARTELS
Suffix:
Gender:F
Credentials:DPT, PRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 S 72ND STREET
Mailing Address - Street 2:SUITE 302
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-1734
Mailing Address - Country:US
Mailing Address - Phone:402-391-2635
Mailing Address - Fax:402-391-0326
Practice Address - Street 1:1910 S 72ND STREET
Practice Address - Street 2:SUITE 302
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-1734
Practice Address - Country:US
Practice Address - Phone:402-391-2635
Practice Address - Fax:402-391-0326
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2382225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE09186OtherBCBS
NE279186Medicare PIN