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General NPI Number Information
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NPI Number | 1750905832
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Entity Type | Individual
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Provider Name | KERRY WALTER BARTLETT PT
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Gender | Male
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Dates
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Enumeration Date | 06/03/2020
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Last Update Date | 06/03/2020
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Provider Practice Location Address
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Address Line | 100 PARKWAY DR
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City | CLARKSBURG
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State | WV
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Zip | 26301-4357
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Country | US
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Telephone | 304-624-6401
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Fax |
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Provider Business Mailing Address
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Address Line | 98 BERNITA WAY
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City | MORGANTOWN
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State | WV
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Zip | 26508-4899
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Country | US
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Telephone | 304-290-2736
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2543
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License Number State | WV
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