Provider Demographics
NPI:1548375009
Name:BAUERLE, JACK HARRY (MS, ATC, CSCS)
Entity type:Individual
Prefix:MR
First Name:JACK
Middle Name:HARRY
Last Name:BAUERLE
Suffix:
Gender:M
Credentials:MS, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3670 SAN ANTONIO RD
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-6972
Mailing Address - Country:US
Mailing Address - Phone:714-394-8127
Mailing Address - Fax:714-970-0999
Practice Address - Street 1:3670 SAN ANTONIO RD
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-6972
Practice Address - Country:US
Practice Address - Phone:714-394-8127
Practice Address - Fax:714-970-0999
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer