MEDICARE: MS. SUSAN BARTOL PT

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	174400000X	Specialist	00571	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1376751263	OTHER	LA	BCBS

General Provider Information

NPI Number	:	1962642926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN BARTOL PT

Provider Business Mailing Address
First Line	:	7855 HOWELL PLACE
Second Line	:	STE. 220
City	:	BATON ROUGE
State	:	LA
Zip	:	70807
Country	:	US
Telephone Number	:	225-454-6005
Fax Number	:	225-454-6018

Provider Business Practice Location Address
First Line	:	7855 HOWELL PLACE BLVD
Second Line	:	STE 220
City	:	BATON ROUGE
State	:	LA
Zip	:	70807-5256
Country	:	US
Telephone Number	:	225-454-6005
Fax Number	:	225-454-6018

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

Provider Enumeration Date	:	03/03/2009
Last Update Date	:	03/03/2009

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