Provider Demographics
NPI:1114350451
Name:BAILEY, MARK R (DPT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:R
Last Name:BAILEY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 BEULAH PL
Mailing Address - Street 2:APT. E
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123-3448
Mailing Address - Country:US
Mailing Address - Phone:856-498-0436
Mailing Address - Fax:
Practice Address - Street 1:220-224 SOUTH BROAD STREET
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102
Practice Address - Country:US
Practice Address - Phone:215-985-9390
Practice Address - Fax:215-985-9394
Is Sole Proprietor?:No
Enumeration Date:2013-08-09
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT-022866225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist