Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 2557 | AZ |
NPI | 1093928871 |
---|---|
Provider Name | Mrs. Mellissa Leone Bayles |
First Address | Glendale, AZ 85308 |
Second Address | Phoenix, AZ 85004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 08/07/2007 |