=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285911008
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BAUER REHAB SERVICES II, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2011
-----------------------------------------------------
Last Update Date | 11/08/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5103 EASTMAN AVE SUITE 100
-----------------------------------------------------
City | MIDLAND
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48640-6785
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-832-6999
-----------------------------------------------------
Fax | 989-832-2222
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5103 EASTMAN AVE SUITE 100
-----------------------------------------------------
City | MIDLAND
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48640-6785
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-832-6999
-----------------------------------------------------
Fax | 989-832-2222
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | WALTER BAUER
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 989-832-6999
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 5501004244
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------