Provider Demographics
NPI:1356971386
Name:FLYNN, BAIELY (DPT)
Entity type:Individual
Prefix:
First Name:BAIELY
Middle Name:
Last Name:FLYNN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 ANDREWS AVE
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-1704
Mailing Address - Country:US
Mailing Address - Phone:504-939-1185
Mailing Address - Fax:
Practice Address - Street 1:901 S SWEETWATER ST.
Practice Address - Street 2:
Practice Address - City:WHEELER
Practice Address - State:TX
Practice Address - Zip Code:79096
Practice Address - Country:US
Practice Address - Phone:806-826-5581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-17
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDCP001076T225100000X
LA10526R225100000X
IL070024634225100000X
TX1324590225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist