Provider Demographics
NPI:1548298946
Name:BARTLEY, NICOLE (MSPT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:BARTLEY
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:MCCARTHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:176 WALKER ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854-3126
Mailing Address - Country:US
Mailing Address - Phone:978-452-9252
Mailing Address - Fax:978-970-0271
Practice Address - Street 1:176 WALKER ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-3126
Practice Address - Country:US
Practice Address - Phone:978-452-9252
Practice Address - Fax:978-970-0271
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15108225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY67911OtherBLUE CROSS PROVIDER #
MA468999OtherTUFTS PROVIDER #
MAY67911OtherBLUE CROSS PROVIDER #