Provider Demographics
NPI:1376270850
Name:BAUER, KAITLYN (PT, DPT, CSCS)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:BAUER
Suffix:
Gender:F
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 LE FEVER DR APT 9306
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-4635
Mailing Address - Country:US
Mailing Address - Phone:815-590-3235
Mailing Address - Fax:
Practice Address - Street 1:4663 W 20TH STREET RD
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-3246
Practice Address - Country:US
Practice Address - Phone:970-352-8762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist