Provider Demographics
NPI:1457003683
Name:BAYNES, CASEY MITCHELL (LPTA)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:MITCHELL
Last Name:BAYNES
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 ROSEMERE DR
Mailing Address - Street 2:
Mailing Address - City:TALLASSEE
Mailing Address - State:AL
Mailing Address - Zip Code:36078-6406
Mailing Address - Country:US
Mailing Address - Phone:334-415-8012
Mailing Address - Fax:
Practice Address - Street 1:192 ROSEMERE DR
Practice Address - Street 2:
Practice Address - City:TALLASSEE
Practice Address - State:AL
Practice Address - Zip Code:36078-6406
Practice Address - Country:US
Practice Address - Phone:334-415-8012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTA10682225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALEDU803607451OtherBLUE CROSS BLUE SHIELD