Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT001256E | PA |
N | 2251S0007X | Physical Therapist - Sports | PT001256E | PA |
N | 2251X0800X | Physical Therapist - Orthopedic | PT001256E | PA |
NPI | 1144201658 |
---|---|
Provider Name | Dr. William Robert Bailey |
First Address | Blairsville, PA 15717-8096 |
Second Address | Brookville, PA 15825-4755 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2005 |
Last Update Date | 20/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0013987130004 | (05) | PA |
R07376 | (02) | PA |