Provider Demographics
NPI:1598022196
Name:BAUER, PAULINE LOUISE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:PAULINE
Middle Name:LOUISE
Last Name:BAUER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1236 HACKETT ST
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-4327
Mailing Address - Country:US
Mailing Address - Phone:608-290-4656
Mailing Address - Fax:
Practice Address - Street 1:1236 HACKETT ST
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-4327
Practice Address - Country:US
Practice Address - Phone:608-290-4656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant