Healthcare Provider Details

I. General information

NPI: 1780260760
Provider Name (Legal Business Name): CHASTITY LEIGH BARGERHUFF ACSM-CEP, EIM3
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 09/29/2021
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3690 GRANDVIEW PKWY
BIRMINGHAM AL
35243-3326
US

IV. Provider business mailing address

304 COWETA TRL
OXFORD AL
36203-0299
US

V. Phone/Fax

Practice location:
  • Phone: 205-971-1000
  • Fax:
Mailing address:
  • Phone: 256-310-8205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License Number1065244
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: