Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | PT17968 | FL |
NPI | 1083686521 |
---|---|
Provider Name | Mr. Michael Lee Bailey |
First Address | Jacksonville, FL 32244-5517 |
Second Address | Mayport Naval Station, FL 32228 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2006 |
Last Update Date | 08/07/2007 |