Healthcare Provider Details

I. General information

NPI: 1609874635
Provider Name (Legal Business Name): ARTHUR WILLIAM BAUDENDISTEL PT, DCS, COMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3609 MISSION AVE STE C
CARMICHAEL CA
95608-2955
US

IV. Provider business mailing address

3609 MISSION AVE STE C
CARMICHAEL CA
95608-2955
US

V. Phone/Fax

Practice location:
  • Phone: 916-487-4681
  • Fax: 916-487-4687
Mailing address:
  • Phone: 916-487-4681
  • Fax: 916-487-4687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberCZ11226
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: