Provider Demographics
NPI:1639736606
Name:BAUER, AMBER NOEL (DPT)
Entity Type:Individual
Prefix:DR
First Name:AMBER
Middle Name:NOEL
Last Name:BAUER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MRS
Other - First Name:AMBER
Other - Middle Name:NOEL
Other - Last Name:BAUER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:156 E LAKEWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-2020
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:156 E LAKEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-2020
Practice Address - Country:US
Practice Address - Phone:734-276-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-23
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9666225100000X
MI5501019943225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist