Provider Demographics
NPI:1972862035
Name:BACHTELL, CATHERINE ALBERTA (PTA)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ALBERTA
Last Name:BACHTELL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 BEAVER TRL
Mailing Address - Street 2:
Mailing Address - City:GERRARDSTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25420-3064
Mailing Address - Country:US
Mailing Address - Phone:304-596-0056
Mailing Address - Fax:
Practice Address - Street 1:50 MULBERRY TREE ST
Practice Address - Street 2:
Practice Address - City:CHARLES TOWN
Practice Address - State:WV
Practice Address - Zip Code:25414-1274
Practice Address - Country:US
Practice Address - Phone:304-724-1101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-10
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPTA 001720225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVPTA001720OtherWV BOARD OF PHYSICAL THERAPY