Provider Demographics
NPI:1114282662
Name:BAUDHUIN, NICHOLAS M (DPT)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:M
Last Name:BAUDHUIN
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 1:3754 NICOLET DR
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-9779
Mailing Address - Country:US
Mailing Address - Phone:920-866-2342
Mailing Address - Fax:
Practice Address - Street 1:211 N BROADWAY STE 105
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-2757
Practice Address - Country:US
Practice Address - Phone:920-432-9040
Practice Address - Fax:920-432-9053
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12034024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist