Provider Demographics
NPI:1770650541
Name:BAILEY, MICHAEL DAVID (MPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DAVID
Last Name:BAILEY
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16768 N HIGHWAY 41
Mailing Address - Street 2:
Mailing Address - City:RATHDRUM
Mailing Address - State:ID
Mailing Address - Zip Code:83858-8715
Mailing Address - Country:US
Mailing Address - Phone:208-687-9195
Mailing Address - Fax:208-687-9750
Practice Address - Street 1:16768 N HIGHWAY 41
Practice Address - Street 2:
Practice Address - City:RATHDRUM
Practice Address - State:ID
Practice Address - Zip Code:83858-8715
Practice Address - Country:US
Practice Address - Phone:208-687-9195
Practice Address - Fax:208-687-9750
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDRPT948225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807192900Medicaid
IDTA864OtherBLUE CROSS
ID000010149138OtherBLUE SHIELD
1551752Medicare ID - Type Unspecified
ID807192900Medicaid