Provider Demographics
NPI:1720634066
Name:BIGHAM, BAILEY (PTA)
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:
Last Name:BIGHAM
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:BAILEY
Other - Middle Name:
Other - Last Name:SIMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:229 CARRINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:AR
Mailing Address - Zip Code:72745-8899
Mailing Address - Country:US
Mailing Address - Phone:870-830-7095
Mailing Address - Fax:
Practice Address - Street 1:6636 W SUNSET AVE STE C
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-0971
Practice Address - Country:US
Practice Address - Phone:479-332-6410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4091225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant