Provider Demographics
NPI:1750120549
Name:EBERT, BAILEY RYAN (PT)
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:RYAN
Last Name:EBERT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7402 YORK RD STE 104
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7519
Mailing Address - Country:US
Mailing Address - Phone:410-560-3931
Mailing Address - Fax:410-560-0877
Practice Address - Street 1:7402 YORK RD STE 104
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7519
Practice Address - Country:US
Practice Address - Phone:410-560-3931
Practice Address - Fax:410-560-0877
Is Sole Proprietor?:No
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD29927225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist