Provider Demographics
NPI:1417189127
Name:MONTEITH, KATHRYN BAYLIS (PT, MA)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:BAYLIS
Last Name:MONTEITH
Suffix:
Gender:F
Credentials:PT, MA
Other - Prefix:MS
Other - First Name:KATHY
Other - Middle Name:LYNN
Other - Last Name:BAYLIS-BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT MA
Mailing Address - Street 1:121 S GARFIELD AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-2967
Mailing Address - Country:US
Mailing Address - Phone:231-883-3403
Mailing Address - Fax:866-234-1631
Practice Address - Street 1:121 S GARFIELD AVE
Practice Address - Street 2:SUITE D
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-2967
Practice Address - Country:US
Practice Address - Phone:231-883-3403
Practice Address - Fax:866-234-1631
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-13
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501002138225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist