Healthcare Provider Details

I. General information

NPI: 1205310406
Provider Name (Legal Business Name): PAVLA BARTKOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2018
Last Update Date: 09/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NW 11TH ST STE E31
HERMISTON OR
97838-8604
US

IV. Provider business mailing address

600 NW 11TH ST STE E31
HERMISTON OR
97838-8604
US

V. Phone/Fax

Practice location:
  • Phone: 541-667-3657
  • Fax:
Mailing address:
  • Phone: 541-667-3657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number8668
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: