Provider Demographics
NPI:1790994788
Name:BAILEY, KAREN (PT)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:
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 1:350 LINCOLN ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-1578
Mailing Address - Country:US
Mailing Address - Phone:781-740-4900
Mailing Address - Fax:
Practice Address - Street 1:350 LINCOLN ST
Practice Address - Street 2:SUITE 104
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-1578
Practice Address - Country:US
Practice Address - Phone:781-740-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2677225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA7213831OtherAETNA
MAY65353OtherBCBS
MAY65353OtherBCBS