Provider Demographics
NPI:1003222324
Name:BOLTHOUSE, EMILY (PT, DPT, SCS, CSCS)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:BOLTHOUSE
Suffix:
Gender:F
Credentials:PT, DPT, SCS, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 COOL SPRINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-1631
Mailing Address - Country:US
Mailing Address - Phone:615-791-7257
Mailing Address - Fax:
Practice Address - Street 1:324 COOL SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-1631
Practice Address - Country:US
Practice Address - Phone:615-791-7257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-08
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10652225100000X, 2251S0007X
CA417302251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist