Provider Demographics
NPI:1336635630
Name:DAUER, EMMA REISIG (PT, DPT)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:REISIG
Last Name:DAUER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:REISIG
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1022 DEER VLY
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48158-9482
Mailing Address - Country:US
Mailing Address - Phone:567-230-0762
Mailing Address - Fax:
Practice Address - Street 1:1136 COUNTRY CLUB RD STE A
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-8208
Practice Address - Country:US
Practice Address - Phone:517-265-0293
Practice Address - Fax:517-265-7970
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH015028225100000X
MI5501018016225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist