Healthcare Provider Details

I. General information

NPI: 1639098296
Provider Name (Legal Business Name): BAILEY MILLAN VASTINE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9877 TOURMALINE CT
PARKER CO
80134-3564
US

IV. Provider business mailing address

9877 TOURMALINE CT
PARKER CO
80134-3564
US

V. Phone/Fax

Practice location:
  • Phone: 720-252-0421
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA.0014785
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: