MEDICARE: MR. THEODORE HENRY BARTOSHESKY PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	PTA0000005846	TN

General Provider Information

NPI Number	:	1326427758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THEODORE HENRY BARTOSHESKY PTA

Provider Business Mailing Address
First Line	:	1971 DUNEDIN DR
Second Line	:
City	:	OLD HICKORY
State	:	TN
Zip	:	37138-4633
Country	:	US
Telephone Number	:	302-507-4873
Fax Number	:

Provider Business Practice Location Address
First Line	:	1971 DUNEDIN DR
Second Line	:
City	:	OLD HICKORY
State	:	TN
Zip	:	37138-4633
Country	:	US
Telephone Number	:	302-507-4873
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2015
Last Update Date	:	05/19/2015

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