Provider Demographics
NPI:1003394099
Name:BAUERSFELD, IAN WILLIAM (DPT)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:WILLIAM
Last Name:BAUERSFELD
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 2ND ST APT 1
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6244
Mailing Address - Country:US
Mailing Address - Phone:207-538-2503
Mailing Address - Fax:
Practice Address - Street 1:277 STATE ST STE 1B
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5440
Practice Address - Country:US
Practice Address - Phone:207-922-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT5180225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist