Healthcare Provider Details

I. General information

NPI: 1881531994
Provider Name (Legal Business Name): BAILEY JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 CARPENTER AVE
IRON MOUNTAIN MI
49801-4768
US

IV. Provider business mailing address

1401 CARPENTER AVE
IRON MOUNTAIN MI
49801-4768
US

V. Phone/Fax

Practice location:
  • Phone: 906-970-9199
  • Fax: 855-515-0849
Mailing address:
  • Phone: 906-970-9199
  • Fax: 855-515-0849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501304263
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: