Provider Demographics
NPI:1083193643
Name:BAILEY, KAYDEE (PTA)
Entity Type:Individual
Prefix:
First Name:KAYDEE
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:KAYDEE
Other - Middle Name:
Other - Last Name:WINTERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8530 SNAKEWEED DR
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-3626
Mailing Address - Country:US
Mailing Address - Phone:505-402-7388
Mailing Address - Fax:
Practice Address - Street 1:8530 SNAKEWEED DR
Practice Address - Street 2:
Practice Address - City:CONVERSE
Practice Address - State:TX
Practice Address - Zip Code:78109-3626
Practice Address - Country:US
Practice Address - Phone:505-402-7388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2114899225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant