Provider Demographics
NPI:1346029311
Name:BAHR, ELLEN (DPT)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:BAHR
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 PALOMA AVE APT 110
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-2248
Mailing Address - Country:US
Mailing Address - Phone:618-978-8410
Mailing Address - Fax:
Practice Address - Street 1:455 HICKEY BLVD STE 205
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2630
Practice Address - Country:US
Practice Address - Phone:618-978-8410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist