=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689589269
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BAYLEE CHRISTINE BRAKE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2026
-----------------------------------------------------
Last Update Date | 08/17/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 196 BEN BURTON CIR
-----------------------------------------------------
City | BOGART
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30622-1790
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-205-5437
-----------------------------------------------------
Fax | 678-261-0065
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 196 BEN BURTON CIR
-----------------------------------------------------
City | BOGART
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30622-1790
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-205-5437
-----------------------------------------------------
Fax | 678-261-0065
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251P0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Physical Therapist
-----------------------------------------------------
License Number | PT018538
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------