Healthcare Provider Details

I. General information

NPI: 1245563402
Provider Name (Legal Business Name): PHILIP BAILEY DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2009
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 HAGANMAN LN UNIT D
SOLON IA
52333-9760
US

IV. Provider business mailing address

3207 220TH TRL
AMANA IA
52203-8206
US

V. Phone/Fax

Practice location:
  • Phone: 319-624-1250
  • Fax: 319-624-1252
Mailing address:
  • Phone: 319-622-3551
  • Fax: 319-622-6352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number004148
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: