Provider Demographics
NPI:1558710954
Name:MINTZ, BAILEY (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:
Last Name:MINTZ
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3339 VIRGINIA ST APT 138
Mailing Address - Street 2:
Mailing Address - City:COCONUT GROVE
Mailing Address - State:FL
Mailing Address - Zip Code:33133-6028
Mailing Address - Country:US
Mailing Address - Phone:908-202-3355
Mailing Address - Fax:305-348-1389
Practice Address - Street 1:11310 SW 17TH ST
Practice Address - Street 2:KIRK LANDON FIELDHOUSE 1160
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33199-0001
Practice Address - Country:US
Practice Address - Phone:908-202-3355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL31132255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer