Provider Demographics
NPI:1164643342
Name:BAILEY, BERVEY O (PTA)
Entity Type:Individual
Prefix:
First Name:BERVEY
Middle Name:O
Last Name:BAILEY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 PRESTON OAKS RD
Mailing Address - Street 2:APT.# 2052
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254
Mailing Address - Country:US
Mailing Address - Phone:580-917-3553
Mailing Address - Fax:
Practice Address - Street 1:5800 PRESTON OAKS RD
Practice Address - Street 2:APT.# 2052
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254
Practice Address - Country:US
Practice Address - Phone:580-917-3553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2058248225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant