Healthcare Provider Details

I. General information

NPI: 1154090165
Provider Name (Legal Business Name): EMILY BAEUERLE PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EMILY WILKENS

II. Dates (important events)

Enumeration Date: 09/13/2021
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2814 GRAY FOX RD
MONROE NC
28110-8422
US

IV. Provider business mailing address

1698 HIGHWAY 160 W STE 240
FORT MILL SC
29708-8035
US

V. Phone/Fax

Practice location:
  • Phone: 704-821-0568
  • Fax:
Mailing address:
  • Phone: 704-654-8599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11780
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP21871
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: