Provider Demographics
NPI:1083243489
Name:BAUTIS, ESTHER (PT)
Entity Type:Individual
Prefix:DR
First Name:ESTHER
Middle Name:
Last Name:BAUTIS
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:PO BOX 870158
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-0158
Mailing Address - Country:US
Mailing Address - Phone:908-764-5672
Mailing Address - Fax:
Practice Address - Street 1:3180 E PAMELA DR
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-9965
Practice Address - Country:US
Practice Address - Phone:908-764-5672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-07
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
OR63442225100000X
NY045526225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist