Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 2848572401 | UT |
NPI | 1659940880 |
---|---|
Provider Name | Camille Jacobsen Bailey |
First Address | Murray, UT 84107-6165 |
Second Address | Murray, UT 84107-6165 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2021 |
Last Update Date | 22/06/2021 |