Bauer, Shane D
Bauer, Shane D is an individual health care provider with primary practice located at 355 N Peters Ave , Fond Du Lac WI 54935-8258. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as his primary health care specialty. Bauer, Shane D can be contacted via phone (920) 929-9712.Contact Information
Primary practice address
355 N Peters Ave
Fond Du Lac WI 54935-8258
Phone: (920) 929-9712
Fax: (920) 929-9715
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist | 225100000X | 5173-024 | Wisconsin |
Profile Details
| NPI number | 1144200676 |
|---|---|
| LBN Legal business name | Bauer, Shane D |
| Credentials | Physical Therapist (PT) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 19th, 2006 |
| Last updated | Sep 9th, 2021 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1144200676 | NPPES |
| Wisconsin | MEDICAID | 40340300 |
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