Provider Demographics
NPI:1598398927
Name:BAUER, MARY JO (PTA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JO
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 1:515 S JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:NEW ULM
Mailing Address - State:MN
Mailing Address - Zip Code:56073-2141
Mailing Address - Country:US
Mailing Address - Phone:507-384-1662
Mailing Address - Fax:
Practice Address - Street 1:1324 5TH NORTH ST
Practice Address - Street 2:
Practice Address - City:NEW ULM
Practice Address - State:MN
Practice Address - Zip Code:56073-1514
Practice Address - Country:US
Practice Address - Phone:507-217-5831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-13
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA268225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant