Provider Demographics
NPI:1568355824
Name:BAILEY, EMILY GRACE (PTA)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:GRACE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9509 AUTUMN TRAIL CV
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:TN
Mailing Address - Zip Code:38002-8298
Mailing Address - Country:US
Mailing Address - Phone:901-569-4940
Mailing Address - Fax:
Practice Address - Street 1:9509 AUTUMN TRAIL CV
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:TN
Practice Address - Zip Code:38002-8298
Practice Address - Country:US
Practice Address - Phone:901-569-4940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5974225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant