Provider Demographics
NPI:1548409147
Name:BARTELINK, TRAVIS (DPT)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:BARTELINK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4028 DALE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-9561
Mailing Address - Country:US
Mailing Address - Phone:209-312-9739
Mailing Address - Fax:209-312-9747
Practice Address - Street 1:4028 DALE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-9561
Practice Address - Country:US
Practice Address - Phone:209-312-9739
Practice Address - Fax:209-312-9747
Is Sole Proprietor?:No
Enumeration Date:2009-02-05
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35400174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT35400OtherCALIFORNIA LICENSE
CABS268ZMedicare PIN