Provider Demographics
NPI:1982966891
Name:BARTELT, CONSTANCE HELEN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:CONSTANCE
Middle Name:HELEN
Last Name:BARTELT
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 1:2239 BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WI
Mailing Address - Zip Code:53037-8925
Mailing Address - Country:US
Mailing Address - Phone:262-677-1619
Mailing Address - Fax:
Practice Address - Street 1:5595 HIGHWAY Z
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-9224
Practice Address - Country:US
Practice Address - Phone:262-677-6800
Practice Address - Fax:262-677-6801
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1382-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant