Provider Demographics
NPI:1073690590
Name:BAILEY, STEPHEN DOUGLAS (PT)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:DOUGLAS
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 1:5822 LYONS VIEW PIKE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-6460
Mailing Address - Country:US
Mailing Address - Phone:865-588-6358
Mailing Address - Fax:865-909-9949
Practice Address - Street 1:5822 LYONS VIEW PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-6460
Practice Address - Country:US
Practice Address - Phone:865-588-6358
Practice Address - Fax:865-909-9949
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000003376225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3653962Medicare ID - Type Unspecified