Provider Demographics
NPI:1568686889
Name:CHOCKLEY, BETTY WOODARD (PT)
Entity Type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:WOODARD
Last Name:CHOCKLEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3080 LYNCH STORE RD
Mailing Address - Street 2:B & G SPECIALTY
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-8501
Mailing Address - Country:US
Mailing Address - Phone:336-214-4266
Mailing Address - Fax:
Practice Address - Street 1:3080 LYNCH STORE RD
Practice Address - Street 2:B & G SPECIALTY
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-8501
Practice Address - Country:US
Practice Address - Phone:336-214-4266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1196225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist