Provider Demographics
NPI:1477597706
Name:BOLAN, AMY BETH (PT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:BETH
Last Name:BOLAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:BETH
Other - Last Name:CHOLEWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:5 FRANCES ROAD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07035
Mailing Address - Country:US
Mailing Address - Phone:973-694-1270
Mailing Address - Fax:
Practice Address - Street 1:242 W PARKWAY
Practice Address - Street 2:SUITE 1
Practice Address - City:POMPTON PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07444-1029
Practice Address - Country:US
Practice Address - Phone:973-831-0717
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00914100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist