Provider Demographics
NPI:1356619795
Name:DENNO, BAILEY ELLISON (DPT)
Entity type:Individual
Prefix:MRS
First Name:BAILEY
Middle Name:ELLISON
Last Name:DENNO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:BAILEY
Other - Middle Name:ELLISON
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 382
Mailing Address - Street 2:
Mailing Address - City:TANGENT
Mailing Address - State:OR
Mailing Address - Zip Code:97389-0382
Mailing Address - Country:US
Mailing Address - Phone:503-926-3338
Mailing Address - Fax:503-961-7742
Practice Address - Street 1:525 NW 2ND ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-6487
Practice Address - Country:US
Practice Address - Phone:503-926-3338
Practice Address - Fax:503-961-7742
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-13
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6729261QP2000X
OR225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy