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General NPI Number Information
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NPI Number | 1811561772
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Entity Type | Individual
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Provider Name | BRANDA BAILEY PTA
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Gender | Female
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Dates
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Enumeration Date | 05/16/2021
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Last Update Date | 05/26/2021
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Provider Practice Location Address
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Address Line | 2450 PARR DR
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City | THE VILLAGES
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State | FL
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Zip | 32162-5385
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Country | US
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Telephone | 352-269-3508
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Fax |
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Provider Business Mailing Address
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Address Line | 44829 MONTEREY RD
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City | DELAND
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State | FL
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Zip | 32720-4724
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Country | US
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Telephone | 660-349-0978
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Fax |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA29745
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA29754
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License Number State | FL
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