Provider Demographics
NPI:1942185657
Name:BAUTISTA, NEOLA JYRRA
Entity type:Individual
Prefix:
First Name:NEOLA
Middle Name:JYRRA
Last Name:BAUTISTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 870
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:16652-0870
Mailing Address - Country:US
Mailing Address - Phone:814-506-8212
Mailing Address - Fax:
Practice Address - Street 1:2990 CARLISLE PIKE
Practice Address - Street 2:
Practice Address - City:NEW OXFORD
Practice Address - State:PA
Practice Address - Zip Code:17350-9582
Practice Address - Country:US
Practice Address - Phone:814-506-8212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT031943225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist