Healthcare Provider Details

I. General information

NPI: 1366352593
Provider Name (Legal Business Name): DEVON BARTHOLOMEW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9317 VIENNA RD
MONTROSE MI
48457-9729
US

IV. Provider business mailing address

8513 W BIRCH RUN RD
SAINT CHARLES MI
48655-9641
US

V. Phone/Fax

Practice location:
  • Phone: 810-639-6171
  • Fax:
Mailing address:
  • Phone: 810-955-0900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502005710
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: