Provider Demographics
NPI:1609107911
Name:BAY JAQUES, MAILE (PT)
Entity Type:Individual
Prefix:
First Name:MAILE
Middle Name:
Last Name:BAY JAQUES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MAILE
Other - Middle Name:
Other - Last Name:BAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:481 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-2631
Mailing Address - Country:US
Mailing Address - Phone:424-536-3023
Mailing Address - Fax:310-536-3093
Practice Address - Street 1:481 W 6TH ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-2631
Practice Address - Country:US
Practice Address - Phone:424-536-3023
Practice Address - Fax:310-536-3093
Is Sole Proprietor?:No
Enumeration Date:2010-01-26
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT35890225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT35890OtherPHYSICAL THERAPIST
CAPT35890OtherPHYSICAL THERAPIST