Provider Demographics
NPI:1952398315
Name:BAILEY, KEITH A (MSPT)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:A
Last Name:BAILEY
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8276 PARK RD
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-1275
Mailing Address - Country:US
Mailing Address - Phone:585-343-9496
Mailing Address - Fax:585-815-7666
Practice Address - Street 1:8276 PARK RD
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-1275
Practice Address - Country:US
Practice Address - Phone:585-343-9496
Practice Address - Fax:585-815-7666
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024277225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q00J01Medicare ID - Type Unspecified
P85058Medicare UPIN