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NPI Code Detail

MEDICARE: BAILEY CLARK DPT

MEDICARE:   BAILEY  CLARK  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
1225100000XPhysical TherapistPTH11158AL
2225100000XPhysical TherapistPT004513WV
32255A2300XAthletic Trainer
4225100000XPhysical TherapistCP039534TMD

General Provider Information

NPI Number : 1760980726
Entity Type Code : Individual
Provider Name (Legal Business Name) : BAILEY CLARK DPT
Provider Business Mailing Address
First Line : 2001 BUTTERFIELD RD STE 1600
Second Line :
City : DOWNERS GROVE
State : IL
Zip : 60515-1211
Country : US
Telephone Number : 866-370-8206
Fax Number :
Provider Business Practice Location Address
First Line : 14190A BALTIMORE AVE
Second Line :
City : LAUREL
State : MD
Zip : 20707-5007
Country : US
Telephone Number : 240-542-5924
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2018
Last Update Date : 01/27/2025

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Directions to “ BAILEY CLARK DPT” Practice Location

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