Provider Demographics
NPI:1679817928
Name:BAILEY, STEPHEN K (PT, DPT, CMTPT, FMSC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:K
Last Name:BAILEY
Suffix:
Gender:M
Credentials:PT, DPT, CMTPT, FMSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 NEW FIDELITY CT
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-2665
Mailing Address - Country:US
Mailing Address - Phone:919-258-2714
Mailing Address - Fax:410-648-4878
Practice Address - Street 1:3510 ANDERSON HWY STE 2
Practice Address - Street 2:
Practice Address - City:POWHATAN
Practice Address - State:VA
Practice Address - Zip Code:23139-5846
Practice Address - Country:US
Practice Address - Phone:804-598-2100
Practice Address - Fax:804-598-7624
Is Sole Proprietor?:No
Enumeration Date:2012-11-26
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305207682225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP01462267OtherMEDICARE RR PTAN
VAC05954OtherGROUP MEDICARE PTAN
VA1679817928Medicaid
VAQ41906AMedicare PIN