Healthcare Provider Details

I. General information

NPI: 1356971386
Provider Name (Legal Business Name): BAIELY FLYNN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2020
Last Update Date: 01/17/2020
Certification Date: 01/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 S SWEETWATER ST.
WHEELER TX
79096
US

IV. Provider business mailing address

1108 ANDREWS AVE
METAIRIE LA
70005-1704
US

V. Phone/Fax

Practice location:
  • Phone: 806-826-5581
  • Fax:
Mailing address:
  • Phone: 504-939-1185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP001076T
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10526R
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070024634
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1324590
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: