Provider Demographics
NPI:1548413966
Name:BAILEY, ROBERT EUGENE (PTA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:EUGENE
Last Name:BAILEY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 SE WALLOCK ST
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-5444
Mailing Address - Country:US
Mailing Address - Phone:580-585-5577
Mailing Address - Fax:580-248-9377
Practice Address - Street 1:602 SE WALLOCK ST
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-5444
Practice Address - Country:US
Practice Address - Phone:580-585-5577
Practice Address - Fax:580-248-9377
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant