Healthcare Provider Details

I. General information

NPI: 1457704231
Provider Name (Legal Business Name): BRYCE BAILEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2016
Last Update Date: 07/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4318 SPYRES WAY
MODESTO CA
95356-9259
US

IV. Provider business mailing address

1518 COFFEE RD SUITE I
MODESTO CA
95355-3164
US

V. Phone/Fax

Practice location:
  • Phone: 209-576-0710
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: