Healthcare Provider Details

I. General information

NPI: 1962704684
Provider Name (Legal Business Name): PATRICIA MARY BARTOLUCCI RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2010
Last Update Date: 12/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 11TH AVE
INDIAN ROCKS BEACH FL
33785-3725
US

IV. Provider business mailing address

123 11TH AVE
INDIAN ROCKS BEACH FL
33785-3725
US

V. Phone/Fax

Practice location:
  • Phone: 518-248-0317
  • Fax: 727-238-8088
Mailing address:
  • Phone: 518-248-0317
  • Fax: 727-238-8088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251H1300X
TaxonomyHuman Factors Physical Therapist
License NumberPT 12435
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: