Provider Demographics
NPI:1366096877
Name:BAUERLE, MELISSA (PT, DPT, ATC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:BAUERLE
Suffix:
Gender:F
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3098 CAMPBELL STATION PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-6274
Mailing Address - Country:US
Mailing Address - Phone:615-302-2141
Mailing Address - Fax:615-302-2162
Practice Address - Street 1:3098 CAMPBELL STATION PKWY STE 101
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-6274
Practice Address - Country:US
Practice Address - Phone:615-302-2141
Practice Address - Fax:615-302-2162
Is Sole Proprietor?:No
Enumeration Date:2019-08-01
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNCP027103T225100000X
VA2305212982225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist