Provider Demographics
NPI:1134769250
Name:BARTLETT, MICAH (PTA)
Entity type:Individual
Prefix:
First Name:MICAH
Middle Name:
Last Name:BARTLETT
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 1:3801 SILVER BEACH AVE
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-4326
Mailing Address - Country:US
Mailing Address - Phone:360-543-3413
Mailing Address - Fax:
Practice Address - Street 1:3801 SILVER BEACH AVE
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-4326
Practice Address - Country:US
Practice Address - Phone:360-543-3413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP160597967225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant