Healthcare Provider Details

I. General information

NPI: 1386558476
Provider Name (Legal Business Name): TANJANEKA BAILEY DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2865 E MAIN ST
HUMBOLDT TN
38343-3070
US

IV. Provider business mailing address

55 SINGLE OAK CV
JACKSON TN
38305-8597
US

V. Phone/Fax

Practice location:
  • Phone: 731-784-8405
  • Fax:
Mailing address:
  • Phone: 615-869-8438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: