Provider Demographics
NPI:1285124925
Name:BAUER, CEZANNE (LMT)
Entity type:Individual
Prefix:
First Name:CEZANNE
Middle Name:
Last Name:BAUER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:CEZANNE
Other - Middle Name:
Other - Last Name:GARBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3800 VINE MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-4479
Mailing Address - Country:US
Mailing Address - Phone:541-221-4668
Mailing Address - Fax:
Practice Address - Street 1:3800 VINE MAPLE ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-4479
Practice Address - Country:US
Practice Address - Phone:541-221-4668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24289225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist