Healthcare Provider Details

I. General information

NPI: 1700290129
Provider Name (Legal Business Name): CASSIE MCDONALD BARKLEY M.S., L.A.T., A.T.C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2014
Last Update Date: 06/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5046 HIGHWAY 17 BYP S SUITE 202 AND 203
MYRTLE BEACH SC
29588-4503
US

IV. Provider business mailing address

5046 HIGHWAY 17 BYP S SUITE 202 AND 203
MYRTLE BEACH SC
29588-4503
US

V. Phone/Fax

Practice location:
  • Phone: 843-294-1941
  • Fax: 843-294-1945
Mailing address:
  • Phone: 843-294-1941
  • Fax: 843-294-1945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1483
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: