Provider Demographics
NPI:1588865000
Name:BUMBARGER, BETSY J (ATC L)
Entity type:Individual
Prefix:MS
First Name:BETSY
Middle Name:J
Last Name:BUMBARGER
Suffix:
Gender:F
Credentials:ATC L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1424 RAY SUGGS PL
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-4310
Mailing Address - Country:US
Mailing Address - Phone:704-786-0384
Mailing Address - Fax:
Practice Address - Street 1:5130 NW CABARRUS DR
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-7624
Practice Address - Country:US
Practice Address - Phone:704-788-4111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1340174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist