Healthcare Provider Details

I. General information

NPI: 1144746819
Provider Name (Legal Business Name): BAILEY MIXON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2017
Last Update Date: 08/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 W 75TH ST
MERRIAM KS
66204-2209
US

IV. Provider business mailing address

9401 CARTER DR
OVERLAND PARK KS
66212-4824
US

V. Phone/Fax

Practice location:
  • Phone: 888-913-1910
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPENDING
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11-05746
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: