Provider Demographics
NPI:1871141861
Name:BARTLEY, BRANDY RAE (PTA, BSPTA)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:RAE
Last Name:BARTLEY
Suffix:
Gender:F
Credentials:PTA, BSPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 MARGATE DR
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21060-7166
Mailing Address - Country:US
Mailing Address - Phone:231-373-9322
Mailing Address - Fax:
Practice Address - Street 1:331 MARGATE DR
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21060-7166
Practice Address - Country:US
Practice Address - Phone:231-373-9322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA3838225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant