MEDICARE: MRS. CASEY KAREN BARTOLO MPT

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	225100000X	Physical Therapist	1637	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578605325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CASEY KAREN BARTOLO MPT

Provider Business Mailing Address
First Line	:	1815 E LAKE MEAD BLVD STE 200
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89030-7189
Country	:	US
Telephone Number	:	702-685-0440
Fax Number	:	702-974-6717

Provider Business Practice Location Address
First Line	:	1815 E LAKE MEAD BLVD STE 200
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89030-7189
Country	:	US
Telephone Number	:	702-685-0440
Fax Number	:	702-974-6717

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

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	05/10/2022

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