Provider Demographics
NPI:1457835845
Name:BAU, MARK ALAN (DPT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALAN
Last Name:BAU
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2965 E TARPON DR STE 150
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-9007
Mailing Address - Country:US
Mailing Address - Phone:208-972-0918
Mailing Address - Fax:208-416-6635
Practice Address - Street 1:1810 S DOROTHY AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-3826
Practice Address - Country:US
Practice Address - Phone:605-356-8888
Practice Address - Fax:605-231-9239
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SDPT-2088225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist