Healthcare Provider Details

I. General information

NPI: 1265417612
Provider Name (Legal Business Name): DEAN L BARTELSON PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 01/19/2021
Certification Date: 01/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W AVE S
LA CROSSE WI
54601
US

IV. Provider business mailing address

700 W AVE S ATTN PHYSICIAN SERVICES
LA CROSSE WI
54601
US

V. Phone/Fax

Practice location:
  • Phone: 608-791-9768
  • Fax: 608-791-7124
Mailing address:
  • Phone: 608-791-4156
  • Fax: 608-791-9898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number544
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: