Provider Demographics
NPI:1164265708
Name:PIERCE, BAYLEE BAIR
Entity type:Individual
Prefix:
First Name:BAYLEE
Middle Name:BAIR
Last Name:PIERCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BAYLEE
Other - Middle Name:
Other - Last Name:BAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:124 W 1309 S
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-8243
Mailing Address - Country:US
Mailing Address - Phone:406-459-1693
Mailing Address - Fax:
Practice Address - Street 1:124 W 1309 S
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-8243
Practice Address - Country:US
Practice Address - Phone:406-459-1693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13950998-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist