Provider Demographics
NPI:1003386830
Name:BAUMANN, AMANDA (PT, DPT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:BAUMANN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:BORIEO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:3025 GULL RD
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-1281
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3025 GULL RD
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-1281
Practice Address - Country:US
Practice Address - Phone:269-552-5530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-05
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501018873225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist