MEDICARE: WILMA JEAN BAILEY

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	225200000X	Physical Therapy Assistant	2034841	TX

General Provider Information

NPI Number	:	1770787384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILMA JEAN BAILEY

Provider Business Mailing Address
First Line	:	715 E 2ND ST
Second Line	:
City	:	COLEMAN
State	:	TX
Zip	:	76834-5127
Country	:	US
Telephone Number	:	325-625-4439
Fax Number	:

Provider Business Practice Location Address
First Line	:	2713 S COMMERCIAL AVE
Second Line	:
City	:	COLEMAN
State	:	TX
Zip	:	76834-7503
Country	:	US
Telephone Number	:	325-625-1591
Fax Number	:	325-625-1591

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

Provider Enumeration Date	:	06/14/2007
Last Update Date	:	07/08/2007

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Directions to “ WILMA JEAN BAILEY ” Practice Location

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