Provider Demographics
NPI:1609239896
Name:BAUSANO, ERIC (ATC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:BAUSANO
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 QUINCY ST
Mailing Address - Street 2:APT 2
Mailing Address - City:HANCOCK
Mailing Address - State:MI
Mailing Address - Zip Code:49930-1933
Mailing Address - Country:US
Mailing Address - Phone:906-483-1831
Mailing Address - Fax:
Practice Address - Street 1:820 QUINCY ST
Practice Address - Street 2:APT 2
Practice Address - City:HANCOCK
Practice Address - State:MI
Practice Address - Zip Code:49930-1933
Practice Address - Country:US
Practice Address - Phone:906-483-1831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL25472362255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer