Provider Demographics
NPI:1356300594
Name:BARTHOLOMEW, JAMES TIMOTHY (PT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:TIMOTHY
Last Name:BARTHOLOMEW
Suffix:
Gender:M
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:PO BOX 181
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:LA
Mailing Address - Zip Code:70437-0181
Mailing Address - Country:US
Mailing Address - Phone:985-893-0778
Mailing Address - Fax:985-893-0301
Practice Address - Street 1:19105 SANDY LN
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-8715
Practice Address - Country:US
Practice Address - Phone:985-893-0778
Practice Address - Fax:985-893-0301
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPT00186225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5C584Medicare ID - Type UnspecifiedGROUP PROVIDER #
LA5S791Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER #