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NPI Code Detail

MEDICARE: JESSICA BAUER

MEDICARE: JESSICA BAUER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist

General Provider Information

NPI Number : 1811476963
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA BAUER
Provider Business Mailing Address
First Line : 2615 JUPITER DR
Second Line :
City : FAIRFIELD
State : OH
Zip : 45014-5099
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5858 BRIDGETOWN RD
Second Line :
City : CINCINNATI
State : OH
Zip : 45248-3106
Country : US
Telephone Number : 513-574-2372
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2018
Last Update Date : 08/04/2023

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