Provider Demographics
NPI:1003173790
Name:BAILEY, WILLIAM ALAN (PT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ALAN
Last Name:BAILEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 CAMP RD
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:AR
Mailing Address - Zip Code:72550-9547
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:706 OAK GROVE ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:AR
Practice Address - Zip Code:72560-8601
Practice Address - Country:US
Practice Address - Phone:870-269-7059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT 32242251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics