Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | PT 3224 | AR |
NPI | 1003173790 |
---|---|
Provider Name | William Alan Bailey |
First Address | Locust Grove, AR 72550-9547 |
Second Address | Mountain View, AR 72560-8601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2012 |
Last Update Date | 18/04/2012 |