Provider Demographics
NPI:1710901152
Name:BAYLISS, DARREN MARC (PT)
Entity Type:Individual
Prefix:
First Name:DARREN
Middle Name:MARC
Last Name:BAYLISS
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 1:600 OAKMONT LN STE 600C
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5548
Mailing Address - Country:US
Mailing Address - Phone:630-575-6250
Mailing Address - Fax:630-575-7450
Practice Address - Street 1:5510 ABRAMS RD STE 115
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-2099
Practice Address - Country:US
Practice Address - Phone:214-265-9704
Practice Address - Fax:214-265-9705
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ36162251E1200X, 2251S0007X
TX1231280225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251E1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistErgonomics
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0464010OtherBLUE CROSS OF ARIZONA
AZ11492100OtherCAQH
AZ6696796OtherGHI
AZ952681OtherAHCCCS
AZ105129Medicare PIN
AZ952681OtherAHCCCS