Healthcare Provider Details

I. General information

NPI: 1063539799
Provider Name (Legal Business Name): ALANA K BARTLETT PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 10/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 W 2ND ST
LEAVENWORTH IN
47137-2264
US

IV. Provider business mailing address

SOUTH ARKANSAS REHABILITATION 1200 OLD WARREN ROAD
MONTICELLO AR
71655-9723
US

V. Phone/Fax

Practice location:
  • Phone: 812-739-2292
  • Fax:
Mailing address:
  • Phone: 870-367-1548
  • Fax: 870-367-1383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05009202A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: