Provider Demographics
NPI:1346441771
Name:BAUCH, CHRISTINE M (PT)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:M
Last Name:BAUCH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 RHODE ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CT
Mailing Address - Zip Code:06370-1417
Mailing Address - Country:US
Mailing Address - Phone:617-584-8882
Mailing Address - Fax:
Practice Address - Street 1:2440 GOLD STAR HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:MYSTIC
Practice Address - State:CT
Practice Address - Zip Code:06355-1180
Practice Address - Country:US
Practice Address - Phone:860-536-1001
Practice Address - Fax:860-536-1527
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9631225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA601057OtherTUFTS HEALTH PLAN
MAY69054Medicare ID - Type UnspecifiedMEDICARE B