MEDICARE: DARREN MARC BAYLISS P.T.

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	2251E1200X	Ergonomics Physical Therapist	3616	AZ
2	2251S0007X	Sports Physical Therapist	3616	AZ
3	225100000X	Physical Therapist	1231280	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AZ0464010	OTHER	AZ	BLUE CROSS OF ARIZONA
2	11492100	OTHER	AZ	CAQH
3	6696796	OTHER	AZ	GHI
4	952681	OTHER	AZ	AHCCCS

General Provider Information

NPI Number	:	1710901152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARREN MARC BAYLISS P.T.

Provider Business Mailing Address
First Line	:	600 OAKMONT LN STE 600C
Second Line	:
City	:	WESTMONT
State	:	IL
Zip	:	60559-5548
Country	:	US
Telephone Number	:	630-575-6250
Fax Number	:	630-575-7450

Provider Business Practice Location Address
First Line	:	5510 ABRAMS RD STE 115
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75214-2099
Country	:	US
Telephone Number	:	214-265-9704
Fax Number	:	214-265-9705

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	10/01/2019

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Directions to “ DARREN MARC BAYLISS P.T.” Practice Location

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