Provider Demographics
NPI:1386235067
Name:BINGHAM, BAILEY ALLEN (ATC)
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:ALLEN
Last Name:BINGHAM
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 N KNOLL APT 205
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-2253
Mailing Address - Country:US
Mailing Address - Phone:916-690-4355
Mailing Address - Fax:
Practice Address - Street 1:7915 W LOOP 1604 N
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78254-4659
Practice Address - Country:US
Practice Address - Phone:254-335-0101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20000406852255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty