Provider Demographics
NPI:1619164423
Name:BACH, JOHN W (PT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:BACH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-3876
Mailing Address - Country:US
Mailing Address - Phone:262-547-2123
Mailing Address - Fax:262-547-6204
Practice Address - Street 1:1451 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-3876
Practice Address - Country:US
Practice Address - Phone:262-547-2123
Practice Address - Fax:262-547-6204
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4521-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist