Provider Demographics
NPI:1629748561
Name:BARTLEY, MARIA N (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:N
Last Name:BARTLEY
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4538 AVA LN
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48348-5174
Mailing Address - Country:US
Mailing Address - Phone:248-920-3142
Mailing Address - Fax:
Practice Address - Street 1:4538 AVA LN
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48348-5174
Practice Address - Country:US
Practice Address - Phone:248-920-3142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012342225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist