Provider Demographics
NPI:1578106274
Name:BAILEY, VALENTINO (MS ED)
Entity Type:Individual
Prefix:
First Name:VALENTINO
Middle Name:
Last Name:BAILEY
Suffix:
Gender:M
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1657 N MIAMI AVE APT 515
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-2010
Mailing Address - Country:US
Mailing Address - Phone:310-367-7517
Mailing Address - Fax:
Practice Address - Street 1:1657 N MIAMI AVE APT 515
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-2010
Practice Address - Country:US
Practice Address - Phone:310-367-7517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225700000X, 251K00000X
1060542226300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No251K00000XAgenciesPublic Health or Welfare