Provider Demographics
NPI:1023201910
Name:BAUER, JENNIFER LYNN (PT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:BAUER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:298 SUNRISE DR
Mailing Address - Street 2:
Mailing Address - City:MINA
Mailing Address - State:SD
Mailing Address - Zip Code:57451-3013
Mailing Address - Country:US
Mailing Address - Phone:605-359-1462
Mailing Address - Fax:
Practice Address - Street 1:1401 PEARL ST
Practice Address - Street 2:
Practice Address - City:FAULKTON
Practice Address - State:SD
Practice Address - Zip Code:57438-2219
Practice Address - Country:US
Practice Address - Phone:605-598-6214
Practice Address - Fax:605-598-6773
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0807225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist