Provider Demographics
NPI:1205656568
Name:BARTOLOME, ISMAEL JOSON (PT)
Entity type:Individual
Prefix:
First Name:ISMAEL
Middle Name:JOSON
Last Name:BARTOLOME
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10414 SHARKTOOTH PEAK DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-8920
Mailing Address - Country:US
Mailing Address - Phone:562-219-1392
Mailing Address - Fax:
Practice Address - Street 1:10414 SHARKTOOTH PEAK DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-8920
Practice Address - Country:US
Practice Address - Phone:562-219-1392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26697225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty