Provider Demographics
NPI:1841081924
Name:BARTHOLOMEW, KRYSTAL (LMT)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:
Last Name:BARTHOLOMEW
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 CHURCH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-1518
Mailing Address - Country:US
Mailing Address - Phone:914-506-5777
Mailing Address - Fax:
Practice Address - Street 1:95 CHURCH ST STE 200
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-1518
Practice Address - Country:US
Practice Address - Phone:914-506-5777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY03087401225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist