Provider Demographics
NPI:1316234271
Name:BARTOLETTI, JOSEPH W
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:W
Last Name:BARTOLETTI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9827 MAPLE GROVE PKWY N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-4491
Mailing Address - Country:US
Mailing Address - Phone:952-993-1460
Mailing Address - Fax:952-993-0116
Practice Address - Street 1:9827 MAPLE GROVE PKWY N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4491
Practice Address - Country:US
Practice Address - Phone:952-993-1460
Practice Address - Fax:952-993-0116
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8787225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN446631Medicare PIN