Provider Demographics
NPI:1700396785
Name:BARTELS, NICOLE ARIEL (DPT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ARIEL
Last Name:BARTELS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10474 SANTA MONICA BLVD STE 435
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-6932
Mailing Address - Country:US
Mailing Address - Phone:310-275-4137
Mailing Address - Fax:310-274-1815
Practice Address - Street 1:10474 SANTA MONICA BLVD STE 435
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-6932
Practice Address - Country:US
Practice Address - Phone:310-275-4137
Practice Address - Fax:310-274-1815
Is Sole Proprietor?:No
Enumeration Date:2017-10-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT293380225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist