Provider Demographics
NPI:1376780528
Name:BAILEY, JEFFREY ALLEN (ATC, NCTM)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ALLEN
Last Name:BAILEY
Suffix:
Gender:M
Credentials:ATC, NCTM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5132 DUMFRIES RD
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20187-8925
Mailing Address - Country:US
Mailing Address - Phone:540-270-8175
Mailing Address - Fax:
Practice Address - Street 1:22525 BELMONT RIDGE RD
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20148-6925
Practice Address - Country:US
Practice Address - Phone:703-957-4408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-09
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0126001289174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist