Provider Demographics
NPI:1639211139
Name:BAUER, KRISTI MARIE HAGEN (MSPT, ATC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:MARIE HAGEN
Last Name:BAUER
Suffix:
Gender:F
Credentials:MSPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5114 LAKE RD
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:NY
Mailing Address - Zip Code:14414-9626
Mailing Address - Country:US
Mailing Address - Phone:585-226-2187
Mailing Address - Fax:
Practice Address - Street 1:3506 THOMAS DR
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:NY
Practice Address - Zip Code:14480-9730
Practice Address - Country:US
Practice Address - Phone:585-346-0060
Practice Address - Fax:585-346-0108
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026428-12251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic