Provider Demographics
NPI:1629255633
Name:BAUER, ALISON A (MPT)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:A
Last Name:BAUER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:A
Other - Last Name:GASSNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:625 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-8813
Mailing Address - Country:US
Mailing Address - Phone:630-575-6200
Mailing Address - Fax:630-928-5080
Practice Address - Street 1:336 FESTUS CENTRE DR
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-2458
Practice Address - Country:US
Practice Address - Phone:636-224-7511
Practice Address - Fax:636-638-2199
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
MO2008009814225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO224791511Medicare PIN
MO224791509Medicare PIN