Provider Demographics
NPI:1528079704
Name:BAILS, WILLIAM JEREMY (MSPT, DPT)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:JEREMY
Last Name:BAILS
Suffix:
Gender:M
Credentials:MSPT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 PEMBERTON DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801
Mailing Address - Country:US
Mailing Address - Phone:410-749-5050
Mailing Address - Fax:410-749-5057
Practice Address - Street 1:1502 PEMBERTON DR
Practice Address - Street 2:SUITE C
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801
Practice Address - Country:US
Practice Address - Phone:410-749-5050
Practice Address - Fax:410-749-5057
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20434174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF1060004OtherBCBS FEDERAL NUMBER
MDLV43OtherBCBS MD NUMBER
MD362636OtherMAMSI NUMBER
MD143839ZCMGOtherMEDICARE GROUP MEMBER PROVIDER NUMBER
MD612956020004OtherBLUE CROSS BLUE SHIELD