Healthcare Provider Details

I. General information

NPI: 1013992866
Provider Name (Legal Business Name): JOSEPH EDWARD BAILEY PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 LANE AVE #201
CHULA VISTA CA
91914-3501
US

IV. Provider business mailing address

885 CANARIOS CT 110
CHULA VISTA CA
91910-7877
US

V. Phone/Fax

Practice location:
  • Phone: 619-421-9521
  • Fax: 619-421-9568
Mailing address:
  • Phone: 619-656-5102
  • Fax: 619-656-5143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT14480
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: