Provider Demographics
NPI:1063539799
Name:BARTLETT, ALANA K (PT)
Entity type:Individual
Prefix:
First Name:ALANA
Middle Name:K
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SOUTH ARKANSAS REHABILITATION
Mailing Address - Street 2:1200 OLD WARREN ROAD
Mailing Address - City:MONTICELLO
Mailing Address - State:AR
Mailing Address - Zip Code:71655-9723
Mailing Address - Country:US
Mailing Address - Phone:870-367-1548
Mailing Address - Fax:870-367-1383
Practice Address - Street 1:712 W 2ND ST
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:IN
Practice Address - Zip Code:47137-2264
Practice Address - Country:US
Practice Address - Phone:812-739-2292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05009202A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN05009202AOtherPHYSICAL THERAPIST LIC