Provider Demographics
NPI:1659574143
Name:BAYERL, TAMMY LYNN (PTA)
Entity Type:Individual
Prefix:MISS
First Name:TAMMY
Middle Name:LYNN
Last Name:BAYERL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 W WINTERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-1947
Mailing Address - Country:US
Mailing Address - Phone:920-730-0702
Mailing Address - Fax:
Practice Address - Street 1:620 HARPER AVE
Practice Address - Street 2:
Practice Address - City:PESHTIGO
Practice Address - State:WI
Practice Address - Zip Code:54157-1134
Practice Address - Country:US
Practice Address - Phone:715-582-4148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1112-019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant