Provider Demographics
NPI:1558090225
Name:BYNUM, BAILEY T (DPT)
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:T
Last Name:BYNUM
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 W 20TH ST
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39440-1802
Mailing Address - Country:US
Mailing Address - Phone:601-428-2004
Mailing Address - Fax:
Practice Address - Street 1:1707 W 20TH ST
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-1802
Practice Address - Country:US
Practice Address - Phone:601-428-2004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSPT7320OtherLICENSE