Provider Demographics
NPI:1861649196
Name:OLSON-BAUER, NANCY ALICE (PT)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:ALICE
Last Name:OLSON-BAUER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MONDOVI
Mailing Address - State:WI
Mailing Address - Zip Code:54755-1625
Mailing Address - Country:US
Mailing Address - Phone:715-926-5177
Mailing Address - Fax:715-926-5137
Practice Address - Street 1:428 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MONDOVI
Practice Address - State:WI
Practice Address - Zip Code:54755-1625
Practice Address - Country:US
Practice Address - Phone:715-926-5177
Practice Address - Fax:715-926-5137
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-18
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2615-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40065200Medicaid