Provider Demographics
NPI:1265259501
Name:BARTOLOME, RAYMOND CRISOSTOMO (DPT)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:CRISOSTOMO
Last Name:BARTOLOME
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6104 BARTON SPRINGS CT
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-2180
Mailing Address - Country:US
Mailing Address - Phone:915-929-2339
Mailing Address - Fax:
Practice Address - Street 1:801 S LOOP 250 W
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79703-2134
Practice Address - Country:US
Practice Address - Phone:432-689-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1231510225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist