Healthcare Provider Details

I. General information

NPI: 1689589269
Provider Name (Legal Business Name): BAYLEE CHRISTINE BRAKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

196 BEN BURTON CIR
BOGART GA
30622-1790
US

IV. Provider business mailing address

196 BEN BURTON CIR
BOGART GA
30622-1790
US

V. Phone/Fax

Practice location:
  • Phone: 678-205-5437
  • Fax: 678-261-0065
Mailing address:
  • Phone: 678-205-5437
  • Fax: 678-261-0065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT018538
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: