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NPI Code Detail

MEDICARE: BAUER PHYSICAL THERAPY LLC

MEDICARE: BAUER PHYSICAL THERAPY LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QP2000XPhysical Therapy Clinic/Center5173024WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1437271012
Entity Type Code : Organization
Provider Name (Legal Business Name) : BAUER PHYSICAL THERAPY LLC
Provider Business Mailing Address
First Line : 355 N PETERS AVE
Second Line :
City : FOND DU LAC
State : WI
Zip : 54935-8258
Country : US
Telephone Number : 920-929-9712
Fax Number : 920-929-9715
Provider Business Practice Location Address
First Line : 355 N PETERS AVE
Second Line :
City : FOND DU LAC
State : WI
Zip : 54935-8258
Country : US
Telephone Number : 920-929-9712
Fax Number : 920-929-9715
Authorized Official
Title or Position : P.T.
Name : MR. SHANE D BAUER
Credential :
Telephone Number : 920-929-9712
Provider Enumeration Date : 04/04/2007
Last Update Date : 07/02/2008

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Directions to “BAUER PHYSICAL THERAPY LLC ” Practice Location

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