Healthcare Provider Details

I. General information

NPI: 1700384690
Provider Name (Legal Business Name): BAYLIE ROBINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2018
Last Update Date: 12/10/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1558 MIDWAY AVE.
AMMON ID
83406
US

IV. Provider business mailing address

4440 E HENSLEY DR
IDAHO FALLS ID
83401-1407
US

V. Phone/Fax

Practice location:
  • Phone: 208-709-4660
  • Fax:
Mailing address:
  • Phone: 208-709-4660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: