Provider Demographics
NPI:1669073573
Name:BAILEY, KYLE W
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:W
Last Name:BAILEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33900 HARPER AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-4258
Mailing Address - Country:US
Mailing Address - Phone:586-350-2644
Mailing Address - Fax:
Practice Address - Street 1:118 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DELPHI
Practice Address - State:IN
Practice Address - Zip Code:46923-1543
Practice Address - Country:US
Practice Address - Phone:765-626-0540
Practice Address - Fax:765-626-0541
Is Sole Proprietor?:No
Enumeration Date:2020-11-06
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05013992A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist