Provider Demographics
NPI:1659707313
Name:BAILEY, ALISHA RENAE (PT)
Entity Type:Individual
Prefix:MRS
First Name:ALISHA
Middle Name:RENAE
Last Name:BAILEY
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 1:245 WINDWARD WAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3133
Mailing Address - Country:US
Mailing Address - Phone:406-756-8488
Mailing Address - Fax:
Practice Address - Street 1:245 WINDWARD WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3133
Practice Address - Country:US
Practice Address - Phone:406-756-8488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-25
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY004306225100000X
MT7702225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist