Provider Demographics
NPI:1184132581
Name:BAUMANN, JEANNE (PTA)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:BAUMANN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 EAGLE ROCK AVE
Mailing Address - Street 2:
Mailing Address - City:EAST HANOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07936-3167
Mailing Address - Country:US
Mailing Address - Phone:973-887-9000
Mailing Address - Fax:973-887-3816
Practice Address - Street 1:630 BROAD ST
Practice Address - Street 2:
Practice Address - City:CARLSTADT
Practice Address - State:NJ
Practice Address - Zip Code:07072-1169
Practice Address - Country:US
Practice Address - Phone:201-507-0717
Practice Address - Fax:201-507-0718
Is Sole Proprietor?:No
Enumeration Date:2018-01-19
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00066400225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant