Provider Demographics
NPI:1942489885
Name:BAUER, DENNIS GEORGE (PTA)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:GEORGE
Last Name:BAUER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4444 RESERVOIR BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55421-3255
Mailing Address - Country:US
Mailing Address - Phone:763-782-1657
Mailing Address - Fax:
Practice Address - Street 1:4444 RESERVOIR BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBIA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55421-3255
Practice Address - Country:US
Practice Address - Phone:763-782-1657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-28
Last Update Date:2007-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant