Provider Demographics
NPI:1063098382
Name:TYSON, BAILEY ANNE (DPT)
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:ANNE
Last Name:TYSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:BAILEY
Other - Middle Name:
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 306393
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-6393
Mailing Address - Country:US
Mailing Address - Phone:615-373-1350
Mailing Address - Fax:
Practice Address - Street 1:1728 FORDHAM BLVD STE 115
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2332
Practice Address - Country:US
Practice Address - Phone:919-883-4454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCP004190T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist