Provider Demographics
NPI:1780614230
Name:BAUER, WALTER (PT)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:
Last Name:BAUER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2203 CANDLESTICK LN
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-3165
Mailing Address - Country:US
Mailing Address - Phone:989-832-6999
Mailing Address - Fax:989-322-2222
Practice Address - Street 1:2203 CANDLESTICK LN
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48642-3165
Practice Address - Country:US
Practice Address - Phone:989-832-6999
Practice Address - Fax:989-322-2222
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501004244225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist