Healthcare Provider Details

I. General information

NPI: 1326984774
Provider Name (Legal Business Name): MARIE BAHR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 OLD JACKSONVILLE RD
SPRINGFIELD IL
62711-8353
US

IV. Provider business mailing address

4021 EAGLE WING RD
SPRINGFIELD IL
62711-8092
US

V. Phone/Fax

Practice location:
  • Phone: 217-204-1644
  • Fax:
Mailing address:
  • Phone: 217-204-1644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070027285
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: