Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1231280 | TX |
N | 2251E1200X | Ergonomics | 3616 | AZ |
N | 225XE1200X | Ergonomics | 3616 | AZ |
N | 2251S0007X | Physical Therapist - Sports | 3616 | AZ |
NPI | 1710901152 |
---|---|
Provider Name | Darren Marc Bayliss |
First Address | Westmont, IL 60559-5548 |
Second Address | Dallas, TX 75214-2099 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 01/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11492100 | CAQH (01) | AZ |
6696796 | GHI (01) | AZ |
952681 | AHCCCS (01) | AZ |
AZ0464010 | BLUE CROSS OF ARIZONA (01) | AZ |