Healthcare Provider Details

I. General information

NPI: 1194173799
Provider Name (Legal Business Name): AIENA LAYA ANGELES BAUTISTA GRIFFITH PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AIENA A BAUTISTA PT

II. Dates (important events)

Enumeration Date: 05/25/2016
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 E 1400 N STE 140
LOGAN UT
84341-2549
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
HOOVER AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 435-213-3850
  • Fax:
Mailing address:
  • Phone: 423-238-7217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14216123-2401
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number19703
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: