Healthcare Provider Details

I. General information

NPI: 1144648650
Provider Name (Legal Business Name): KATHLEEN BAILEY DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2014
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 YORK RD BUILDING A, SUITE 300
LUTHERVILLE MD
21093-6016
US

IV. Provider business mailing address

1300 YORK RD BUILDING A, SUITE 300
LUTHERVILLE MD
21093-6016
US

V. Phone/Fax

Practice location:
  • Phone: 410-828-4629
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number24183
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: