Provider Demographics
NPI:1972388668
Name:THUSTON, BAILEY RENEE (DPT)
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:RENEE
Last Name:THUSTON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:BAILEY
Other - Middle Name:R
Other - Last Name:WILCOXSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 219297
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64121-9297
Mailing Address - Country:US
Mailing Address - Phone:816-232-1137
Mailing Address - Fax:816-232-1331
Practice Address - Street 1:139 N BELT HWY STE N
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-3445
Practice Address - Country:US
Practice Address - Phone:816-232-1137
Practice Address - Fax:816-232-1331
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023032466225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist