Healthcare Provider Details

I. General information

NPI: 1922489061
Provider Name (Legal Business Name): LAUREN R. BAIER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2015
Last Update Date: 02/09/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 LEAD AVE SE
ALBUQUERQUE NM
87108-2844
US

IV. Provider business mailing address

4400 LEAD AVE SE
ALBUQUERQUE NM
87108-2844
US

V. Phone/Fax

Practice location:
  • Phone: 505-266-3655
  • Fax: 505-268-2771
Mailing address:
  • Phone: 505-266-2655
  • Fax: 660-785-1825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2015016086
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: