Provider Demographics
NPI:1609547447
Name:HAVENS, BAILEY (PT)
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:
Last Name:HAVENS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9483 OAK BAY RD
Mailing Address - Street 2:
Mailing Address - City:PORT LUDLOW
Mailing Address - State:WA
Mailing Address - Zip Code:98365-9794
Mailing Address - Country:US
Mailing Address - Phone:360-437-2444
Mailing Address - Fax:360-437-4190
Practice Address - Street 1:9483 OAK BAY RD
Practice Address - Street 2:
Practice Address - City:PORT LUDLOW
Practice Address - State:WA
Practice Address - Zip Code:98365-9794
Practice Address - Country:US
Practice Address - Phone:360-437-2444
Practice Address - Fax:360-437-4190
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-22
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61155754225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist