Provider Demographics
NPI:1972859940
Name:BAILEY, MAURA CATHERINE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MAURA
Middle Name:CATHERINE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 306393
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-6393
Mailing Address - Country:US
Mailing Address - Phone:615-373-1350
Mailing Address - Fax:
Practice Address - Street 1:3135 KIRBY WHITTEN RD STE 105&106
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-2860
Practice Address - Country:US
Practice Address - Phone:901-213-2900
Practice Address - Fax:901-213-0004
Is Sole Proprietor?:No
Enumeration Date:2012-07-27
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSCP003691T225100000X
TN9244225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0446645Medicaid
TN3133295OtherBLUE CROSS BLUE SHIELD PROVIDER
TN446645Medicare PIN