Provider Demographics
NPI:1235196577
Name:BARTHOLOMEW, JENNIFER EVE (PT)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:EVE
Last Name:BARTHOLOMEW
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 BOSTON POST RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385
Mailing Address - Country:US
Mailing Address - Phone:860-444-8713
Mailing Address - Fax:860-444-1671
Practice Address - Street 1:86 BOSTON POST RD
Practice Address - Street 2:SUITE
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385
Practice Address - Country:US
Practice Address - Phone:860-444-8713
Practice Address - Fax:860-444-1671
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005619225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist