Healthcare Provider Details

I. General information

NPI: 1013583335
Provider Name (Legal Business Name): JONATHAN DEAN BAILEY PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2021
Last Update Date: 01/17/2022
Certification Date: 01/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3790 PLEASANT HILL RD STE 100
DULUTH GA
30096-5143
US

IV. Provider business mailing address

6397 LEE HWY
CHATTANOOGA TN
37421-2564
US

V. Phone/Fax

Practice location:
  • Phone: 770-497-4228
  • Fax:
Mailing address:
  • Phone: 423-238-3473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPENDING
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP006299T
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT015277
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13736
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: