Healthcare Provider Details

I. General information

NPI: 1750894531
Provider Name (Legal Business Name): MICHAEL WILLIAM BAYER DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2017
Last Update Date: 11/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1987 STATE ROUTE 52 STE 11
LIBERTY NY
12754-8317
US

IV. Provider business mailing address

16 MAYBROOK RD STE A
CAMPBELL HALL NY
10916-2741
US

V. Phone/Fax

Practice location:
  • Phone: 845-292-8580
  • Fax: 845-292-8909
Mailing address:
  • Phone: 845-636-4344
  • Fax: 845-636-4355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number042631
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: