Provider Demographics
NPI:1912124405
Name:BARTELS, DOUG ALAN (BS, MA)
Entity Type:Individual
Prefix:MR
First Name:DOUG
Middle Name:ALAN
Last Name:BARTELS
Suffix:
Gender:M
Credentials:BS, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 ARCH STONE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-2353
Mailing Address - Country:US
Mailing Address - Phone:210-497-7152
Mailing Address - Fax:
Practice Address - Street 1:8711 VILLAGE DR
Practice Address - Street 2:SUITE 109
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5418
Practice Address - Country:US
Practice Address - Phone:210-297-2725
Practice Address - Fax:210-297-0215
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1092328225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist