Provider Demographics
NPI:1447746110
Name:EDWARDS, BAILEY (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 LEWISTON OAKS CT
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-9192
Mailing Address - Country:US
Mailing Address - Phone:336-339-4486
Mailing Address - Fax:
Practice Address - Street 1:2747 NC HIGHWAY 47
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-8626
Practice Address - Country:US
Practice Address - Phone:336-339-4486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT-35612255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer