Healthcare Provider Details

I. General information

NPI: 1659940880
Provider Name (Legal Business Name): CAMILLE JACOBSEN BAILEY MPT, NCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2021
Last Update Date: 06/22/2021
Certification Date: 06/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5770 S 250 E STE G50
MURRAY UT
84107-6165
US

IV. Provider business mailing address

5770 S 250 E STE G50
MURRAY UT
84107-6165
US

V. Phone/Fax

Practice location:
  • Phone: 801-314-5000
  • Fax:
Mailing address:
  • Phone: 801-314-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number2848572401
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: