Provider Demographics
NPI:1104949353
Name:BOLTON, CAROLINE M (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:M
Last Name:BOLTON
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:569 SKYLINE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-3911
Mailing Address - Country:US
Mailing Address - Phone:731-427-7888
Mailing Address - Fax:731-265-4152
Practice Address - Street 1:569 SKYLINE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3911
Practice Address - Country:US
Practice Address - Phone:731-427-7888
Practice Address - Fax:731-265-4152
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000004486225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3709355Medicaid
TN36516531Medicare PIN