Provider Demographics
NPI:1912205121
Name:BAYLES, MUMTAZ KHAN (PT)
Entity Type:Individual
Prefix:MRS
First Name:MUMTAZ
Middle Name:KHAN
Last Name:BAYLES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:MUMTAZ
Other - Middle Name:JAHAN
Other - Last Name:KHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16162 FAIRWAY LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-2718
Mailing Address - Country:US
Mailing Address - Phone:562-458-1625
Mailing Address - Fax:
Practice Address - Street 1:16162 FAIRWAY LN
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-2718
Practice Address - Country:US
Practice Address - Phone:562-458-1625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-11
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 23488225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist