MEDICARE: JESSICA NICOLE BAUERKEMPER PT, DPT

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
1	225100000X	Physical Therapist	9062634-2401	UT

General Provider Information

NPI Number	:	1649670878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA NICOLE BAUERKEMPER PT, DPT

Provider Business Mailing Address
First Line	:	1265 E FORT UNION BLVD
Second Line	:	STE 110
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84047-1808
Country	:	US
Telephone Number	:	801-849-0198
Fax Number	:	801-849-0492

Provider Business Practice Location Address
First Line	:	1265 E FORT UNION BLVD
Second Line	:	STE 110
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84047-1808
Country	:	US
Telephone Number	:	801-849-0198
Fax Number	:	801-849-0492

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2014
Last Update Date	:	05/03/2015

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