MEDICARE: KAREN BAUTISTA 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
1	261QP2000X	Physical Therapy Clinic/Center	40QA00973600	NJ

General Provider Information

NPI Number	:	1922247451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN BAUTISTA PT

Provider Business Mailing Address
First Line	:	1048 STONE ST
Second Line	:
City	:	UNION
State	:	NJ
Zip	:	07083-5904
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 HAMBURG TPKE STE 200
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-2049
Country	:	US
Telephone Number	:	973-595-7500
Fax Number	:

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

Provider Enumeration Date	:	02/06/2009
Last Update Date	:	02/06/2009

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Directions to “ KAREN BAUTISTA PT” Practice Location

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