Provider Demographics
NPI:1114068152
Name:BAUER, RANDALL GARY (RPT)
Entity Type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:GARY
Last Name:BAUER
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27071 CABOT RD
Mailing Address - Street 2:#101
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-7024
Mailing Address - Country:US
Mailing Address - Phone:949-588-7278
Mailing Address - Fax:949-588-7331
Practice Address - Street 1:27071 CABOT RD
Practice Address - Street 2:#101
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-7024
Practice Address - Country:US
Practice Address - Phone:949-588-7278
Practice Address - Fax:949-588-7331
Is Sole Proprietor?:No
Enumeration Date:2007-02-11
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 14376225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT14376AMedicare PIN