Provider Demographics
NPI:1760509699
Name:BAILEY, JASON THOMAS (MS ATC, CSCS)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:THOMAS
Last Name:BAILEY
Suffix:
Gender:M
Credentials:MS ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 TRILLINGHAM LN
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-3035
Mailing Address - Country:US
Mailing Address - Phone:919-481-0591
Mailing Address - Fax:
Practice Address - Street 1:1400 EDWARDS MILL RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-3624
Practice Address - Country:US
Practice Address - Phone:919-861-2308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12732255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer