Provider Demographics
NPI:1780895664
Name:BAILEY, YVETTE FERNANDEZ (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:YVETTE
Middle Name:FERNANDEZ
Last Name:BAILEY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-4243
Mailing Address - Country:US
Mailing Address - Phone:305-978-2358
Mailing Address - Fax:
Practice Address - Street 1:723 3RD AVE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-4243
Practice Address - Country:US
Practice Address - Phone:305-978-2358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22816225100000X
GAPT009038225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511I650323Medicare PIN