Provider Demographics
NPI:1639223860
Name:BAER, DIANE (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:
Last Name:BAER
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1992
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80150-1992
Mailing Address - Country:US
Mailing Address - Phone:303-781-7855
Mailing Address - Fax:303-781-7826
Practice Address - Street 1:3765 S BROADWAY
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-3611
Practice Address - Country:US
Practice Address - Phone:303-781-7855
Practice Address - Fax:303-781-7826
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20082251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO61558851Medicaid
CO61558851Medicaid
COCE6023Medicare PIN