Provider Demographics
NPI:1467832709
Name:FEGLEY, JUSTIN AARON (LAT,ATC)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:AARON
Last Name:FEGLEY
Suffix:
Gender:M
Credentials:LAT,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 THORNWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-2334
Mailing Address - Country:US
Mailing Address - Phone:570-691-5884
Mailing Address - Fax:
Practice Address - Street 1:419 THORNWOOD RD
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-2334
Practice Address - Country:US
Practice Address - Phone:570-691-5884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-02
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23402255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer