Provider Demographics
NPI:1144399213
Name:BAUM, MICHAEL HOWARD (PT CFMT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:HOWARD
Last Name:BAUM
Suffix:
Gender:M
Credentials:PT CFMT
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 275
Mailing Address - Street 2:321 HOLLY STREET
Mailing Address - City:JUNCTION CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97448-0275
Mailing Address - Country:US
Mailing Address - Phone:541-998-9988
Mailing Address - Fax:541-998-6280
Practice Address - Street 1:321 HOLLY STREET
Practice Address - Street 2:
Practice Address - City:JUNCTION CITY
Practice Address - State:OR
Practice Address - Zip Code:97448-0275
Practice Address - Country:US
Practice Address - Phone:541-998-9988
Practice Address - Fax:541-998-9987
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2756225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR130604Medicaid
2382OtherTIN
ORR118681Medicare ID - Type Unspecified