Provider Demographics
NPI:1871688010
Name:BAILEY, KAREN J (PT)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:J
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 1:18 SKYLARK RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-2016
Mailing Address - Country:US
Mailing Address - Phone:207-510-6500
Mailing Address - Fax:207-510-6565
Practice Address - Street 1:5 MILLBROOK RD
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-9702
Practice Address - Country:US
Practice Address - Phone:207-510-6500
Practice Address - Fax:207-510-6565
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT1272225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME044517OtherANTHEM BC/BS
11223425OtherCAQH
650025318OtherPALMETTO GBA
3011201OtherAETNA/BB
7533401OtherAETNA/KY, TX & CHICKERING
ME044517OtherANTHEM BC/BS
MM9757Medicare ID - Type Unspecified