Provider Demographics
NPI:1437642535
Name:TAMMEN, BAILEY (DPT)
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:
Last Name:TAMMEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:BAILEY
Other - Middle Name:A
Other - Last Name:BOLWERK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1969 WEST HART RD
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-2283
Mailing Address - Country:US
Mailing Address - Phone:630-575-6250
Mailing Address - Fax:
Practice Address - Street 1:1731 HENRY LUCKOW LN
Practice Address - Street 2:
Practice Address - City:BELVIDERE
Practice Address - State:IL
Practice Address - Zip Code:61008
Practice Address - Country:US
Practice Address - Phone:815-544-6967
Practice Address - Fax:815-544-6984
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070023741225100000X
IL070.023741225100000X
WI15385-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist