Individual
CASEY MITCHELL BAYNES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPTA
Contact information
Practice address
192 ROSEMERE DR, TALLASSEE, AL 36078-6406
(334) 415-8012
Mailing address
192 ROSEMERE DR, TALLASSEE, AL 36078-6406
(334) 415-8012
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA10682
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
EDU803607451
BLUE CROSS BLUE SHIELD
AL
Enumeration date
01/19/2022
Last updated
01/19/2022
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