Provider Demographics
NPI:1922331180
Name:BAILEY-LYON, KENDRA (PT)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:BAILEY-LYON
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 1:560 GRADY AVE STE C
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-1975
Mailing Address - Country:US
Mailing Address - Phone:770-461-6488
Mailing Address - Fax:
Practice Address - Street 1:560 GRADY AVE STE C
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-1975
Practice Address - Country:US
Practice Address - Phone:770-461-6488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-04
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT009737225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist