Provider Demographics
NPI:1699006528
Name:BAILEY, LANE BROOKS (PT)
Entity Type:Individual
Prefix:
First Name:LANE
Middle Name:BROOKS
Last Name:BAILEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 FANNIN ST
Mailing Address - Street 2:STE 1620
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1521
Mailing Address - Country:US
Mailing Address - Phone:713-704-6794
Mailing Address - Fax:713-704-9005
Practice Address - Street 1:6400 FANNIN ST
Practice Address - Street 2:STE 1620
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1521
Practice Address - Country:US
Practice Address - Phone:713-704-6794
Practice Address - Fax:713-704-9005
Is Sole Proprietor?:No
Enumeration Date:2010-01-15
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1239423225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist