Provider Demographics
NPI:1831201318
Name:BARTLETT, WADE ALAN (ATC)
Entity type:Individual
Prefix:MR
First Name:WADE
Middle Name:ALAN
Last Name:BARTLETT
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1636 FAIR HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-6110
Mailing Address - Country:US
Mailing Address - Phone:615-302-1363
Mailing Address - Fax:
Practice Address - Street 1:1636 FAIR HOUSE RD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-6110
Practice Address - Country:US
Practice Address - Phone:615-302-1363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAT 00000003352255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer