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General NPI Number Information
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NPI Number | 1457709941
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Entity Type | Individual
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Provider Name | MATTHEW BAYLY
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Gender | Male
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Dates
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Enumeration Date | 05/25/2016
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Last Update Date | 05/25/2016
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Provider Practice Location Address
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Address Line | 750 WEST PIERCE STREET 132 KIRBY SPORTS CENTER
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City | EASTON
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State | PA
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Zip | 18042
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Country | US
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Telephone | 610-330-5766
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Fax | 610-330-5821
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Provider Business Mailing Address
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Address Line | 132 KIRBY SPORTS CENTER, 420 HAMILTON STREET LAFAYETTE COLLEGE
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City | EASTON
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State | PA
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Zip | 18042
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Country | US
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Telephone | 610-330-5766
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Fax | 610-330-5811
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | RT000904A
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License Number State | PA
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