Provider Demographics
NPI:1174614424
Name:BAYLESS, RHONDA M (PT)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:M
Last Name:BAYLESS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 LONE MTN BOAT DOCK LN
Mailing Address - Street 2:
Mailing Address - City:TAZEWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37879-6168
Mailing Address - Country:US
Mailing Address - Phone:423-585-5023
Mailing Address - Fax:423-587-4553
Practice Address - Street 1:280 N FAIRMONT AVE
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-3768
Practice Address - Country:US
Practice Address - Phone:423-585-5023
Practice Address - Fax:423-587-4553
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6160225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0446566Medicaid
TN3123654OtherBCBSTN
TN0446566Medicaid