Provider Demographics
NPI:1235504424
Name:WARD, BAILEY GWENNETH (DPT)
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:GWENNETH
Last Name:WARD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2560 COLORADO BLVD
Mailing Address - Street 2:
Mailing Address - City:EAGLE ROCK
Mailing Address - State:CA
Mailing Address - Zip Code:90041-1005
Mailing Address - Country:US
Mailing Address - Phone:323-255-5409
Mailing Address - Fax:
Practice Address - Street 1:2560 COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:EAGLE ROCK
Practice Address - State:CA
Practice Address - Zip Code:90041-1005
Practice Address - Country:US
Practice Address - Phone:323-255-5409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41651225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist