Provider Demographics
NPI:1962699363
Name:BAILEY, RYAN MICHAEL (MPT)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:MICHAEL
Last Name:BAILEY
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3564 PASEO DE LOS CALIFORNIANOS UNIT 158
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4155
Mailing Address - Country:US
Mailing Address - Phone:909-576-5438
Mailing Address - Fax:
Practice Address - Street 1:3564 PASEO DE LOS CALIFORNIANOS UNIT 158
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4155
Practice Address - Country:US
Practice Address - Phone:909-576-5438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-29
Last Update Date:2007-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27419225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist