Provider Demographics
NPI:1578799912
Name:BARTOLO PHYSICAL THERAPY
Entity Type:Organization
Organization Name:BARTOLO PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:KAREN
Authorized Official - Last Name:BARTOLO
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:702-243-0055
Mailing Address - Street 1:1027 S RAINBOW BLVD
Mailing Address - Street 2:SUITE 261
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-6232
Mailing Address - Country:US
Mailing Address - Phone:702-243-0055
Mailing Address - Fax:702-243-5582
Practice Address - Street 1:1801 S RAINBOW BLVD
Practice Address - Street 2:SUITE 230
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-0001
Practice Address - Country:US
Practice Address - Phone:702-243-0055
Practice Address - Fax:702-243-5582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-29
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1637225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty