Provider Demographics
NPI:1578605325
Name:BARTOLO, CASEY KAREN (MPT)
Entity Type:Individual
Prefix:MRS
First Name:CASEY
Middle Name:KAREN
Last Name:BARTOLO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 E LAKE MEAD BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-7189
Mailing Address - Country:US
Mailing Address - Phone:702-685-0440
Mailing Address - Fax:702-974-6717
Practice Address - Street 1:1815 E LAKE MEAD BLVD STE 200
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-7189
Practice Address - Country:US
Practice Address - Phone:702-685-0440
Practice Address - Fax:702-974-6717
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1637225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1578605325Medicaid
NV1578605325Medicaid