Provider Demographics
NPI:1619126695
Name:BAYLOSIS, CARMENCITA TAMPUS
Entity Type:Individual
Prefix:
First Name:CARMENCITA
Middle Name:TAMPUS
Last Name:BAYLOSIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MENCHIE
Other - Middle Name:TAMPUS
Other - Last Name:BAYLOSIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHYSICAL THERAPIST
Mailing Address - Street 1:2001 CONNECTICUT AVE
Mailing Address - Street 2:APT D2
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1108
Mailing Address - Country:US
Mailing Address - Phone:417-659-9656
Mailing Address - Fax:
Practice Address - Street 1:2001 CONNECTICUT AVE
Practice Address - Street 2:APT D2
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1108
Practice Address - Country:US
Practice Address - Phone:417-659-9656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008027615225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist