Provider Demographics
NPI:1457516577
Name:BAILEY, DEIRDRE JEANNE (PT)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:JEANNE
Last Name:BAILEY
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 1:5201 INDIANA AVE
Mailing Address - Street 2:200 CENTRAL
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79413-4200
Mailing Address - Country:US
Mailing Address - Phone:806-791-2100
Mailing Address - Fax:806-791-2105
Practice Address - Street 1:5201 INDIANA AVE
Practice Address - Street 2:200 CENTRAL
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79413-4200
Practice Address - Country:US
Practice Address - Phone:806-791-2100
Practice Address - Fax:806-791-2105
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030071-1225100000X
TX1110435225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist