Basic Information
| Provider Information | |||||||||
| NPI: | 1205851409 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BARTHELMESS | ||||||||
| FirstName: | DARYL | ||||||||
| MiddleName: | JAMES | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 350 NEW FIDELITY CT | ||||||||
| Address2: | |||||||||
| City: | GARNER | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275292665 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192582714 | ||||||||
| FaxNumber: | 4106484878 | ||||||||
| Practice Location | |||||||||
| Address1: | 29 N ATLANTIC AVE | ||||||||
| Address2: | |||||||||
| City: | OCEAN VIEW | ||||||||
| State: | DE | ||||||||
| PostalCode: | 19970 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3025415705 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 02/18/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | J10001462 | DE | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 800224-45 | 01 | MD | BC/BS SDSCR | OTHER | 1000025977 | 01 | MEDICAID BAYSIDE PT | OTHER | 800224-46 | 01 | MD | BC/BS BAYSIDE PT | OTHER | G02075B02 | 01 | DE | MEDICARE PIN BAYSIDE PT | OTHER | 1000038795 | 01 | DE | MEDICAID SDSCR | OTHER | 013700S53 | 01 | DE | MEDICARE PIN SDSCR | OTHER |