Provider Demographics
NPI:1023400900
Name:BAUMANN, BECKY (PT)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:
Last Name:BAUMANN
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 1:21964 HIGHWAY 32
Mailing Address - Street 2:
Mailing Address - City:SAINTE GENEVIEVE
Mailing Address - State:MO
Mailing Address - Zip Code:63670-9190
Mailing Address - Country:US
Mailing Address - Phone:573-883-9366
Mailing Address - Fax:573-883-9377
Practice Address - Street 1:21964 HIGHWAY 32
Practice Address - Street 2:
Practice Address - City:SAINTE GENEVIEVE
Practice Address - State:MO
Practice Address - Zip Code:63670-9190
Practice Address - Country:US
Practice Address - Phone:573-883-9366
Practice Address - Fax:573-883-9377
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011035383225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist