MEDICARE: DAVID BATHKE II PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	A4926	NC

General Provider Information

NPI Number	:	1164887147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID BATHKE II PTA

Provider Business Mailing Address
First Line	:	282 COOKSON LN
Second Line	:
City	:	MOCKSVILLE
State	:	NC
Zip	:	27028-8267
Country	:	US
Telephone Number	:	336-492-7130
Fax Number	:

Provider Business Practice Location Address
First Line	:	5680 WINDY HILL DR
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27105-1425
Country	:	US
Telephone Number	:	336-776-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/17/2015
Last Update Date	:	12/17/2015

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