Healthcare Provider Details

I. General information

NPI: 1104028075
Provider Name (Legal Business Name): JENNIFER EVE BACHMAN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8501 DOUGHTON DR
BAHAMA NC
27503-8992
US

IV. Provider business mailing address

8501 DOUGHTON DR
BAHAMA NC
27503-8992
US

V. Phone/Fax

Practice location:
  • Phone: 919-620-6666
  • Fax:
Mailing address:
  • Phone: 919-620-6666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number4863
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: