MEDICARE: ANNETTE MARIE BACH

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
1	225200000X	Physical Therapy Assistant	116988	MO

General Provider Information

NPI Number	:	1962103945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNETTE MARIE BACH

Provider Business Mailing Address
First Line	:	16585 CARRIAGE VIEW CT
Second Line	:
City	:	WILDWOOD
State	:	MO
Zip	:	63040-1402
Country	:	US
Telephone Number	:	314-803-3118
Fax Number	:

Provider Business Practice Location Address
First Line	:	16585 CARRIAGE VIEW CT
Second Line	:
City	:	WILDWOOD
State	:	MO
Zip	:	63040-1402
Country	:	US
Telephone Number	:	314-803-3118
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2023
Last Update Date	:	03/15/2023

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Directions to “ ANNETTE MARIE BACH ” Practice Location

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