Provider Demographics
NPI:1194346965
Name:BARE GROUNDS, PATRICIA KELLY (ATC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:KELLY
Last Name:BARE GROUNDS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 TEXANNA WAY
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-7351
Mailing Address - Country:US
Mailing Address - Phone:850-582-2067
Mailing Address - Fax:
Practice Address - Street 1:445 TEXANNA WAY
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-7351
Practice Address - Country:US
Practice Address - Phone:850-582-2067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-02
Last Update Date:2020-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT-24442255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer