Provider Demographics
NPI:1902902570
Name:KREITER, BAYLEN L (PT)
Entity Type:Individual
Prefix:
First Name:BAYLEN
Middle Name:L
Last Name:KREITER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 N DALE LN
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99212-2445
Mailing Address - Country:US
Mailing Address - Phone:509-327-5857
Mailing Address - Fax:509-327-6025
Practice Address - Street 1:1908 N DALE LN
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99212-2445
Practice Address - Country:US
Practice Address - Phone:509-327-5857
Practice Address - Fax:509-327-6025
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT9033225100000X
IDPT-1797225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8373649Medicaid
WA8856146Medicare ID - Type Unspecified