Provider Demographics
NPI:1598575615
Name:PENDLETON, BAYLEY (ATC)
Entity type:Individual
Prefix:
First Name:BAYLEY
Middle Name:
Last Name:PENDLETON
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 1:109 WATER WAY APT 9
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-5896
Mailing Address - Country:US
Mailing Address - Phone:207-380-6459
Mailing Address - Fax:
Practice Address - Street 1:1 AVENUE OF THE ARTS
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-3072
Practice Address - Country:US
Practice Address - Phone:757-594-7980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260039862255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer