Organization
BAUER PHYSICAL THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SHANE D BAUER (P.T.)
(920) 929-9712
Entity
Organization
Contact information
Practice address
355 N PETERS AVE, FOND DU LAC, WI 54935-8258
(920) 929-9712
(920) 929-9715
Mailing address
355 N PETERS AVE, FOND DU LAC, WI 54935-8258
(920) 929-9712
(920) 929-9715
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
5173024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40340300
—
WI
Enumeration date
04/04/2007
Last updated
07/02/2008
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