Provider Demographics
NPI:1447588512
Name:BAUTISTA, ANNA MARIA SOLEMA BAYLE (RPT)
Entity Type:Individual
Prefix:MRS
First Name:ANNA MARIA SOLEMA
Middle Name:BAYLE
Last Name:BAUTISTA
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 W 5TH ST
Mailing Address - Street 2:SUITE D & E
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-2501
Mailing Address - Country:US
Mailing Address - Phone:417-782-2917
Mailing Address - Fax:
Practice Address - Street 1:214 W 5TH ST
Practice Address - Street 2:SUITE D & E
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-2501
Practice Address - Country:US
Practice Address - Phone:417-782-2917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008005174225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist