Healthcare Provider Details

I. General information

NPI: 1972594315
Provider Name (Legal Business Name): PETER BARTEL P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 09/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2312 W MAIN ST 117
BATTLE GROUND WA
98604-4234
US

IV. Provider business mailing address

2312 W MAIN ST 117
BATTLE GROUND WA
98604-4234
US

V. Phone/Fax

Practice location:
  • Phone: 360-687-7147
  • Fax: 360-687-2866
Mailing address:
  • Phone: 360-687-7147
  • Fax: 360-687-2866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1008
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: