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NPI Code Detail

MEDICARE: MRS. RENE D. BADER PT

MEDICARE: MRS. RENE D. BADER PT
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
1174400000XSpecialistPT 767AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15U362OTHERARAR BC/BS PROVIDER NUMBER

General Provider Information

NPI Number : 1821055146
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. RENE D. BADER PT
Provider Business Mailing Address
First Line : 4107 CLARK AVE
Second Line :
City : SPRINGDALE
State : AR
Zip : 72762-5865
Country : US
Telephone Number : 479-751-6059
Fax Number :
Provider Business Practice Location Address
First Line : 1760 N WOODLAND AVE
Second Line :
City : FAYETTEVILLE
State : AR
Zip : 72703-2549
Country : US
Telephone Number : 479-443-4420
Fax Number : 479-443-0547
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/28/2006
Last Update Date : 07/09/2007

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Directions to “ MRS. RENE D. BADER PT” Practice Location

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