Basic Information
| Provider Information | |||||||||
| NPI: | 1114068152 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAUER | ||||||||
| FirstName: | RANDALL | ||||||||
| MiddleName: | GARY | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | R.P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 27071 CABOT RD | ||||||||
| Address2: | #101 | ||||||||
| City: | LAGUNA HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926537024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9495887278 | ||||||||
| FaxNumber: | 9495887331 | ||||||||
| Practice Location | |||||||||
| Address1: | 27071 CABOT RD | ||||||||
| Address2: | #101 | ||||||||
| City: | LAGUNA HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926537024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9495887278 | ||||||||
| FaxNumber: | 9495887331 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2007 | ||||||||
| LastUpdateDate: | 02/27/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT 14376 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.