Provider Demographics
NPI:1922578137
Name:BARTHOLOMEW, AMY E (ATC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:E
Last Name:BARTHOLOMEW
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 SKYHAWK BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:UT
Mailing Address - Zip Code:84653-5559
Mailing Address - Country:US
Mailing Address - Phone:801-423-3200
Mailing Address - Fax:
Practice Address - Street 1:150 SKYHAWK BLVD
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:UT
Practice Address - Zip Code:84653-5559
Practice Address - Country:US
Practice Address - Phone:801-423-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-30
Last Update Date:2019-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8100420-48102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer