Healthcare Provider Details

I. General information

NPI: 1558090225
Provider Name (Legal Business Name): BAILEY T BYNUM DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2022
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 W 20TH ST
LAUREL MS
39440-1802
US

IV. Provider business mailing address

1707 W 20TH ST
LAUREL MS
39440-1802
US

V. Phone/Fax

Practice location:
  • Phone: 601-428-2004
  • Fax: 601-428-8833
Mailing address:
  • Phone: 601-428-2004
  • Fax: 601-428-8833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number7320
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: