Provider Demographics
NPI:1215452057
Name:BAUER, AUDREY LEIGH (PT, DPT)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:LEIGH
Last Name:BAUER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 ASPENWAY DR
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-5514
Mailing Address - Country:US
Mailing Address - Phone:972-746-3355
Mailing Address - Fax:
Practice Address - Street 1:2233 ACADEMY PL STE 50
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1679
Practice Address - Country:US
Practice Address - Phone:719-475-0808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-12
Last Update Date:2017-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0015086225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist