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NPI Code Detail

MEDICARE: MRS. NICOLE C. BAILKE MPT

MEDICARE: MRS. NICOLE C. BAILKE MPT
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
12251P0200XPediatric Physical Therapist9966-024WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1912943796
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. NICOLE C. BAILKE MPT
Provider Business Mailing Address
First Line : 6700 N. PORT WASHINGTON RD.
Second Line : C/O ST. FRANCIS CHILDREN'S CENTER
City : GLENDALE
State : WI
Zip : 53217-3919
Country : US
Telephone Number : 414-351-8850
Fax Number : 414-351-8846
Provider Business Practice Location Address
First Line : 6700 N. PORT WASHINGTON RD.
Second Line : ST. FRANCIS CHILDREN'S CENTER
City : GLENDALE
State : WI
Zip : 53217-3919
Country : US
Telephone Number : 414-351-8850
Fax Number : 414-351-8846
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2006
Last Update Date : 12/12/2011

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