MEDICARE: STEPHEN LEE BAILEY PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	12367	SC

General Provider Information

NPI Number	:	1235971375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN LEE BAILEY PT, DPT

Provider Business Mailing Address
First Line	:	1105 12TH ST
Second Line	:
City	:	CAYCE
State	:	SC
Zip	:	29033-3304
Country	:	US
Telephone Number	:	803-973-0100
Fax Number	:	803-973-0117

Provider Business Practice Location Address
First Line	:	10216 BROAD RIVER RD
Second Line	:
City	:	IRMO
State	:	SC
Zip	:	29063-9679
Country	:	US
Telephone Number	:	803-973-1717
Fax Number	:	803-462-5804

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2024
Last Update Date	:	06/10/2024

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