Healthcare Provider Details

I. General information

NPI: 1043955990
Provider Name (Legal Business Name): LAKYN C BAILEY PT DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2022
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4120 WAVERLY RD
HUNTINGTON WV
25704-1127
US

IV. Provider business mailing address

2700 GREENUP AVE
ASHLAND KY
41101-1953
US

V. Phone/Fax

Practice location:
  • Phone: 606-324-0540
  • Fax: 606-324-0616
Mailing address:
  • Phone: 606-324-0540
  • Fax: 606-324-0616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: