Basic Information
| Provider Information | |||||||||
| NPI: | 1083160600 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAILEY | ||||||||
| FirstName: | ALYSSA | ||||||||
| MiddleName: | |||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 715 N BREWER ST | ||||||||
| Address2: | |||||||||
| City: | VINITA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 743011439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9182569207 | ||||||||
| FaxNumber: | 9182569209 | ||||||||
| Practice Location | |||||||||
| Address1: | 715 N BREWER ST | ||||||||
| Address2: | |||||||||
| City: | VINITA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 743011439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9182569207 | ||||||||
| FaxNumber: | 9182569209 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2016 | ||||||||
| LastUpdateDate: | 09/01/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 5196 | OK | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.