Healthcare Provider Details

I. General information

NPI: 1083686521
Provider Name (Legal Business Name): MICHAEL LEE BAILEY PHYSICAL THERAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 MASSEY AVE
MAYPORT NAVAL STATION FL
32228
US

IV. Provider business mailing address

8152 KILWINNING LN
JACKSONVILLE FL
32244-5517
US

V. Phone/Fax

Practice location:
  • Phone: 904-270-4265
  • Fax:
Mailing address:
  • Phone: 904-874-0363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT17968
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: