Provider Demographics
NPI:1336595313
Name:BADGER, MARTIE Y (PT)
Entity Type:Individual
Prefix:
First Name:MARTIE
Middle Name:Y
Last Name:BADGER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARTIE
Other - Middle Name:B
Other - Last Name:NEUEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:218 FOUST ST STE C
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-5476
Mailing Address - Country:US
Mailing Address - Phone:336-625-2333
Mailing Address - Fax:336-625-5511
Practice Address - Street 1:148 POINTE SOUTH DR
Practice Address - Street 2:
Practice Address - City:RANDLEMAN
Practice Address - State:NC
Practice Address - Zip Code:27317-9520
Practice Address - Country:US
Practice Address - Phone:336-799-4435
Practice Address - Fax:336-799-4057
Is Sole Proprietor?:No
Enumeration Date:2016-05-10
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP16282225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP16282OtherPT LICENSE