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General NPI Number Information
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NPI Number | 1568804003
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Entity Type | Individual
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Provider Name | ALYSSA BAUER ATC
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Gender | Female
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Dates
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Enumeration Date | 07/25/2013
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Last Update Date | 08/18/2025
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Provider Practice Location Address
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Address Line | 9040 JACKSON AVE
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City | TACOMA
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State | WA
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Zip | 98431-7266
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Country | US
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Telephone | 253-968-1110
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Fax |
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Provider Business Mailing Address
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Address Line | 133 MAGNOLIA AVE SE
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City | FORT WALTON BEACH
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State | FL
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Zip | 32548-7266
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Country | US
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Telephone | 860-499-0776
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 0126003018
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License Number State | VA
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