Provider Demographics
NPI:1255726840
Name:BARTISHOFSKI, CHEREE' DELAINE (PTA)
Entity type:Individual
Prefix:
First Name:CHEREE'
Middle Name:DELAINE
Last Name:BARTISHOFSKI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26486 COUNTY ROAD 26
Mailing Address - Street 2:
Mailing Address - City:GARRISON
Mailing Address - State:MN
Mailing Address - Zip Code:56450-2035
Mailing Address - Country:US
Mailing Address - Phone:320-630-7783
Mailing Address - Fax:
Practice Address - Street 1:26486 COUNTY ROAD 26
Practice Address - Street 2:
Practice Address - City:GARRISON
Practice Address - State:MN
Practice Address - Zip Code:56450-2035
Practice Address - Country:US
Practice Address - Phone:320-630-7783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-01
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA267171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor