Provider Demographics
NPI:1750905832
Name:BARTLETT, KERRY WALTER (PT)
Entity type:Individual
Prefix:MR
First Name:KERRY
Middle Name:WALTER
Last Name:BARTLETT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 BERNITA WAY
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-4899
Mailing Address - Country:US
Mailing Address - Phone:304-290-2736
Mailing Address - Fax:
Practice Address - Street 1:100 PARKWAY DR
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-4357
Practice Address - Country:US
Practice Address - Phone:304-624-6401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-03
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2543225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist