Provider Demographics
NPI:1154090165
Name:BAEUERLE, EMILY (PT, DPT)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:BAEUERLE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:WILKENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1698 HIGHWAY 160 W STE 240
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8035
Mailing Address - Country:US
Mailing Address - Phone:704-654-8599
Mailing Address - Fax:
Practice Address - Street 1:1698 HIGHWAY 160 W
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-8032
Practice Address - Country:US
Practice Address - Phone:704-654-8599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-13
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA7009225200000X
SC11780225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty