Provider Demographics
NPI:1164887147
Name:BATHKE, DAVID II (PTA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:BATHKE
Suffix:II
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:282 COOKSON LN
Mailing Address - Street 2:
Mailing Address - City:MOCKSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27028-8267
Mailing Address - Country:US
Mailing Address - Phone:336-492-7130
Mailing Address - Fax:
Practice Address - Street 1:5680 WINDY HILL DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105-1425
Practice Address - Country:US
Practice Address - Phone:336-776-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-17
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA4926225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant