Provider Demographics
NPI:1962274860
Name:BAUR, COLEEN E (PTA)
Entity type:Individual
Prefix:
First Name:COLEEN
Middle Name:E
Last Name:BAUR
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:COLEEN
Other - Middle Name:E
Other - Last Name:JEFFERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:7408 GRAY WOLF LN
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-2066
Mailing Address - Country:US
Mailing Address - Phone:740-542-1040
Mailing Address - Fax:
Practice Address - Street 1:8000 ELDORADO PKWY
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-4136
Practice Address - Country:US
Practice Address - Phone:469-296-3411
Practice Address - Fax:833-410-3610
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2179010208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation