Provider Demographics
NPI:1518549070
Name:KIRBY, BAILEY LAINE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:BAILEY
Middle Name:LAINE
Last Name:KIRBY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 MCILROY RD
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:AR
Mailing Address - Zip Code:72455-5236
Mailing Address - Country:US
Mailing Address - Phone:870-321-2980
Mailing Address - Fax:
Practice Address - Street 1:1600 SW BROAD ST
Practice Address - Street 2:
Practice Address - City:HOXIE
Practice Address - State:AR
Practice Address - Zip Code:72433-2419
Practice Address - Country:US
Practice Address - Phone:870-679-1506
Practice Address - Fax:870-679-1507
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-24
Last Update Date:2021-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA4445225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant