Healthcare Provider Details

I. General information

NPI: 1033763719
Provider Name (Legal Business Name): BAILEE SUMNER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2019
Last Update Date: 08/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4686 E ASBURY CIR
DENVER CO
80222-4723
US

IV. Provider business mailing address

9085 E MISSISSIPPI AVE APT F101
DENVER CO
80247-6801
US

V. Phone/Fax

Practice location:
  • Phone: 303-756-1566
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number0014646
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: