Provider Demographics
NPI:1427752450
Name:SPAHN, BAILEY (LMT)
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:
Last Name:SPAHN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 PINE DR
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-6325
Mailing Address - Country:US
Mailing Address - Phone:631-987-0647
Mailing Address - Fax:
Practice Address - Street 1:1850 SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-6012
Practice Address - Country:US
Practice Address - Phone:631-583-3300
Practice Address - Fax:631-583-3301
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033242225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist