Provider Demographics
NPI:1134414063
Name:RODRIGUEZ BARTELT, CELESTE (PT)
Entity type:Individual
Prefix:
First Name:CELESTE
Middle Name:
Last Name:RODRIGUEZ BARTELT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CELESTE
Other - Middle Name:
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3770 8TH ST SW
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALTOONA
Mailing Address - State:IA
Mailing Address - Zip Code:50009-1048
Mailing Address - Country:US
Mailing Address - Phone:515-967-5025
Mailing Address - Fax:515-967-2360
Practice Address - Street 1:3770 8TH ST SW
Practice Address - Street 2:SUITE A
Practice Address - City:ALTOONA
Practice Address - State:IA
Practice Address - Zip Code:50009-1048
Practice Address - Country:US
Practice Address - Phone:515-967-5025
Practice Address - Fax:515-967-2360
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11875225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1134414063Medicaid
IAI19172Medicare PIN
WI1134414063Medicaid