Provider Demographics
NPI:1225774722
Name:BARTOLOMEU, AMANDA LYNN (CMT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYNN
Last Name:BARTOLOMEU
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 ROCKY HILL RD APT K
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-2992
Mailing Address - Country:US
Mailing Address - Phone:707-392-9760
Mailing Address - Fax:
Practice Address - Street 1:602 ROCKY HILL RD APT K
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-2992
Practice Address - Country:US
Practice Address - Phone:708-392-9769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-08
Last Update Date:2022-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33818225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist