Provider Demographics
NPI:1467745323
Name:BAILEY, ELAINE (PT,, DPT)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:PT,, DPT
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:NICOLE DAVIS
Other - Last Name:SNUFFER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:101 CLYDE MORRIS BLVD
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-8230
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 CLYDE MORRIS BLVD
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8230
Practice Address - Country:US
Practice Address - Phone:386-310-4920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 25583225100000X
VA2305212526225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist