Healthcare Provider Details

I. General information

NPI: 1073627832
Provider Name (Legal Business Name): SANDRA L BAUSMAN PT, WCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 03/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2763 E SHAW AVE # 102
FRESNO CA
93710-8220
US

IV. Provider business mailing address

2763 E SHAW AVE # 102
FRESNO CA
93710-8220
US

V. Phone/Fax

Practice location:
  • Phone: 559-294-8112
  • Fax: 559-294-7805
Mailing address:
  • Phone: 559-294-8112
  • Fax: 559-294-7805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT94950
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: