Provider Demographics
NPI:1174559009
Name:BAUER, TODD BRIAN (PT)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:BRIAN
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 1:760 TURNPIKE TPKE
Mailing Address - Street 2:
Mailing Address - City:POMPTON PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07444-1326
Mailing Address - Country:US
Mailing Address - Phone:973-902-3687
Mailing Address - Fax:
Practice Address - Street 1:242 W PARKWAY
Practice Address - Street 2:SUITE 1
Practice Address - City:POMPTON PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07444-1029
Practice Address - Country:US
Practice Address - Phone:973-831-0717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00709300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist