Provider Demographics
NPI:1477847556
Name:BAUER, MATTHEW J (DPT)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:J
Last Name:BAUER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4472 BUFFALO RD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16510-2228
Mailing Address - Country:US
Mailing Address - Phone:814-464-0660
Mailing Address - Fax:814-464-0663
Practice Address - Street 1:4472 BUFFALO RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16510-2228
Practice Address - Country:US
Practice Address - Phone:814-464-0660
Practice Address - Fax:814-464-0663
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT021263225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist