Provider Demographics
NPI:1801800859
Name:BAYLON, MARIA THERESA (RPT)
Entity type:Individual
Prefix:
First Name:MARIA THERESA
Middle Name:
Last Name:BAYLON
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:MARIA THERESA
Other - Middle Name:A
Other - Last Name:BAYLON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:29542 CROWN CREEK
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677
Mailing Address - Country:US
Mailing Address - Phone:949-429-3220
Mailing Address - Fax:949-429-3885
Practice Address - Street 1:27136 B PASEO ESPADA
Practice Address - Street 2:STE 1103
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675
Practice Address - Country:US
Practice Address - Phone:949-429-3220
Practice Address - Fax:949-429-3885
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2015-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT18463225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OPT184630OtherBLUE SHIELD
W15279Medicare ID - Type Unspecified