Provider Demographics
NPI:1124072012
Name:BAILEY, DENISE L (PT)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:L
Last Name:BAILEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 S MAIN ST
Mailing Address - Street 2:SUITES A B
Mailing Address - City:SUGAR GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60554-5031
Mailing Address - Country:US
Mailing Address - Phone:630-466-5866
Mailing Address - Fax:630-466-5869
Practice Address - Street 1:38 S MAIN ST
Practice Address - Street 2:SUITES A B
Practice Address - City:SUGAR GROVE
Practice Address - State:IL
Practice Address - Zip Code:60554-5031
Practice Address - Country:US
Practice Address - Phone:630-466-5866
Practice Address - Fax:630-466-5869
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070016823225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2418306Medicaid
IL36-4395802OtherTAX ID NUMBER
IL36-4395802OtherTAX ID NUMBER