Healthcare Provider Details

I. General information

NPI: 1336595313
Provider Name (Legal Business Name): MARTIE BADGER NEEL PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARTIE B BADGER PT, DPT

II. Dates (important events)

Enumeration Date: 05/10/2016
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 GALLBERRY LN
WAXHAW NC
28173-0161
US

IV. Provider business mailing address

216 N BICKETT BLVD STE 2
LOUISBURG NC
27549-2473
US

V. Phone/Fax

Practice location:
  • Phone: 704-649-4509
  • Fax:
Mailing address:
  • Phone: 919-298-2331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP16282
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: