Provider Demographics
NPI:1306011721
Name:BAUER, JULIA LYNN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:LYNN
Last Name:BAUER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W234N7096 FLINTLOCK DR E
Mailing Address - Street 2:
Mailing Address - City:SUSSEX
Mailing Address - State:WI
Mailing Address - Zip Code:53089-3200
Mailing Address - Country:US
Mailing Address - Phone:262-246-9127
Mailing Address - Fax:
Practice Address - Street 1:5434 W CAPITOL DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-2298
Practice Address - Country:US
Practice Address - Phone:414-444-4822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-26
Last Update Date:2008-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1063019172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI36123800Medicaid