Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant |
NPI | 1013072024 |
---|---|
Provider Name | Mrs. Heather Bartlett |
First Address | Owensboro, KY 42302 |
Second Address | Owensboro, KY 42303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11903135ICF | (05) | KY |
33000035SCL | (05) | KY |
4S118379EPSDT | (05) | KY |