Healthcare Provider Details

I. General information

NPI: 1609348002
Provider Name (Legal Business Name): BRENT ANTHONY BARTLETT DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2018
Last Update Date: 12/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 W AVENUE L
LANCASTER CA
93534-8827
US

IV. Provider business mailing address

44229 SHAD ST
LANCASTER CA
93536-6120
US

V. Phone/Fax

Practice location:
  • Phone: 661-948-1999
  • Fax: 661-948-6699
Mailing address:
  • Phone: 661-803-2381
  • Fax: 661-948-6699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT295735
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT295735
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: