Provider Demographics
NPI:1821367418
Name:BAUMGARTNER, JULIE M (PTA)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:M
Last Name:BAUMGARTNER
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:PO BOX 146
Mailing Address - Street 2:
Mailing Address - City:CEDARVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61013-0146
Mailing Address - Country:US
Mailing Address - Phone:608-558-8819
Mailing Address - Fax:
Practice Address - Street 1:2448 SOUTH 102ND ST STE 340
Practice Address - Street 2:MJ CARE INC
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53227
Practice Address - Country:US
Practice Address - Phone:414-329-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-28
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1227-19225200000X
IL160.006021225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant