Provider Demographics
NPI:1093323883
Name:ANDREWS, BAILIE NICHOLE (LPTA, OPTA)
Entity Type:Individual
Prefix:
First Name:BAILIE
Middle Name:NICHOLE
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:LPTA, OPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1058 COUNTY ROAD 447
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35057-3162
Mailing Address - Country:US
Mailing Address - Phone:256-338-9981
Mailing Address - Fax:
Practice Address - Street 1:1640 2ND AVE SW
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-5313
Practice Address - Country:US
Practice Address - Phone:256-841-5185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-17
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTA8180225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant