Provider Demographics
NPI:1679207591
Name:BAUER, CHANTAL REA BOUGIE
Entity Type:Individual
Prefix:
First Name:CHANTAL REA
Middle Name:BOUGIE
Last Name:BAUER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 W 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54902-6905
Mailing Address - Country:US
Mailing Address - Phone:920-420-6239
Mailing Address - Fax:
Practice Address - Street 1:4 HAMPTON HALL BLVD
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-7812
Practice Address - Country:US
Practice Address - Phone:843-837-1930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-15
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist