Provider Demographics
NPI:1174163802
Name:HOUSTON, BAYLEE (MS, LAT, ATC)
Entity type:Individual
Prefix:
First Name:BAYLEE
Middle Name:
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 ROCKEFELLER AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-4729
Mailing Address - Country:US
Mailing Address - Phone:425-422-9481
Mailing Address - Fax:
Practice Address - Street 1:446 AUTUMN FALLS DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38112-1047
Practice Address - Country:US
Practice Address - Phone:425-422-9481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-10
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAA1611797672255A2300X
2255A2300X
UT1240225348102255A2300X
MTATR-LAT-LIC-24872255A2300X
AL28012255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer