Provider Demographics
NPI:1417144130
Name:BAETEN, ANGELA M (PT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:BAETEN
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 1:3654 US HIGHWAY 141
Mailing Address - Street 2:
Mailing Address - City:ABRAMS
Mailing Address - State:WI
Mailing Address - Zip Code:54101-9743
Mailing Address - Country:US
Mailing Address - Phone:920-826-7651
Mailing Address - Fax:
Practice Address - Street 1:3654 US HIGHWAY 141
Practice Address - Street 2:
Practice Address - City:ABRAMS
Practice Address - State:WI
Practice Address - Zip Code:54101-9743
Practice Address - Country:US
Practice Address - Phone:920-826-7651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3265225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40112200Medicaid