Healthcare Provider Details

I. General information

NPI: 1740298702
Provider Name (Legal Business Name): BAUER REHABILITATION SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 02/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2203 CANDLESTICK LN
MIDLAND MI
48642-3165
US

IV. Provider business mailing address

2203 CANDLESTICK LN
MIDLAND MI
48642-3165
US

V. Phone/Fax

Practice location:
  • Phone: 989-430-9457
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501010076
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201004579
License Number StateMI

VIII. Authorized Official

Name: PAMELA BAUER
Title or Position: OWNER
Credential:
Phone: 989-430-9457