Provider Demographics
NPI:1164592317
Name:BAILEY, JANELLE M (PT)
Entity Type:Individual
Prefix:MRS
First Name:JANELLE
Middle Name:M
Last Name:BAILEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:JANELLE
Other - Middle Name:M
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3863 WOODLAND AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-1971
Mailing Address - Country:US
Mailing Address - Phone:417-848-7413
Mailing Address - Fax:417-881-2918
Practice Address - Street 1:3045 S NATIONAL AVE
Practice Address - Street 2:STE 200
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-4247
Practice Address - Country:US
Practice Address - Phone:417-881-2900
Practice Address - Fax:417-881-2918
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003025129225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO219434472Medicare ID - Type Unspecified