Provider Demographics
NPI:1285742437
Name:BARTELL, CYNTHIA L (RPT)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:L
Last Name:BARTELL
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 S CHRISTIAN AVE
Mailing Address - Street 2:SUITE B P.O.BOX767
Mailing Address - City:MOUNDRIDGE
Mailing Address - State:KS
Mailing Address - Zip Code:67107-9000
Mailing Address - Country:US
Mailing Address - Phone:620-345-7600
Mailing Address - Fax:620-345-7604
Practice Address - Street 1:135 S CHRISTIAN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MOUNDRIDGE
Practice Address - State:KS
Practice Address - Zip Code:67107-9000
Practice Address - Country:US
Practice Address - Phone:620-345-7600
Practice Address - Fax:620-345-7604
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-00618225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100398670AMedicaid
KS100398670AMedicaid