Provider Demographics
NPI:1609550847
Name:BARTOLACCI, ROBERT (PTA)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:BARTOLACCI
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2590 HIGHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BRODHEADSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18322-7050
Mailing Address - Country:US
Mailing Address - Phone:570-269-2271
Mailing Address - Fax:
Practice Address - Street 1:2600 NORTHAMPTON ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-2656
Practice Address - Country:US
Practice Address - Phone:610-250-0150
Practice Address - Fax:610-559-8936
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI005231225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant