Provider Demographics
NPI:1649619867
Name:BAUER, JEFFREY WILLIAM (PTA)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:WILLIAM
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 1:26 SANDPIPER DR
Mailing Address - Street 2:
Mailing Address - City:PARLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08859-2151
Mailing Address - Country:US
Mailing Address - Phone:732-501-9259
Mailing Address - Fax:
Practice Address - Street 1:26 SANDPIPER DR
Practice Address - Street 2:
Practice Address - City:PARLIN
Practice Address - State:NJ
Practice Address - Zip Code:08859-2151
Practice Address - Country:US
Practice Address - Phone:732-501-9259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00288800225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ40QB00288800OtherPTA LICENSE