Provider Demographics
NPI:1962642926
Name:BARTOL, SUSAN (PT)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:BARTOL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7855 HOWELL PLACE
Mailing Address - Street 2:STE. 220
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70807
Mailing Address - Country:US
Mailing Address - Phone:225-454-6005
Mailing Address - Fax:225-454-6018
Practice Address - Street 1:7855 HOWELL PLACE BLVD
Practice Address - Street 2:STE 220
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70807-5256
Practice Address - Country:US
Practice Address - Phone:225-454-6005
Practice Address - Fax:225-454-6018
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA00571174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1376751263OtherBCBS