Provider Demographics
NPI:1821025859
Name:BARTHOLOMEW, JOHN ALBERT JR (ATC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ALBERT
Last Name:BARTHOLOMEW
Suffix:JR
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S PINE ST
Mailing Address - Street 2:
Mailing Address - City:LAMONI
Mailing Address - State:IA
Mailing Address - Zip Code:50140-1527
Mailing Address - Country:US
Mailing Address - Phone:641-784-4677
Mailing Address - Fax:641-784-5039
Practice Address - Street 1:201 S PINE ST
Practice Address - Street 2:
Practice Address - City:LAMONI
Practice Address - State:IA
Practice Address - Zip Code:50140-1527
Practice Address - Country:US
Practice Address - Phone:641-784-4677
Practice Address - Fax:641-784-5039
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer