Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 2305202468 | VA |
N | 2251P0200X | Physical Therapist - Pediatrics | 2305202468 | VA |
NPI | 1124449764 |
---|---|
Provider Name | Mrs. Kathleen Bailey |
First Address | Alexandria, VA 22314-4512 |
Second Address | Alexandria, VA 22314-4512 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2013 |
Last Update Date | 29/12/2013 |