Provider Demographics
NPI:1376511808
Name:BAILEY, TAMMY LYN (PT)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:LYN
Last Name:BAILEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 434, BOX 264
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09138
Mailing Address - Country:DE
Mailing Address - Phone:01762-262-4585
Mailing Address - Fax:
Practice Address - Street 1:CMR 434, BOX 264
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09138
Practice Address - Country:DE
Practice Address - Phone:01762-262-4585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4735225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO4735OtherPT LICENSE