Basic Information
| Provider Information | |||||||||
| NPI: | 1821545005 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARTLEY | ||||||||
| FirstName: | WENDY | ||||||||
| MiddleName: | T | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MASOKA | ||||||||
| OtherFirstName: | WENDY | ||||||||
| OtherMiddleName: | T | ||||||||
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| OtherNameSuffix: | |||||||||
| OtherCredential: | PT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4140 FERNCREEK DR | ||||||||
| Address2: | SUITE 801 | ||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283142563 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104842171 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4140 FERNCREEK DR | ||||||||
| Address2: | SUITE 801 | ||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283142563 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104842171 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2016 | ||||||||
| LastUpdateDate: | 09/07/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | P16521 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.