MEDICARE: KYLE FRED BALDWIN PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT 19105	CA

General Provider Information

NPI Number	:	1174652481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE FRED BALDWIN PT

Provider Business Mailing Address
First Line	:	5214 E LOS ALTOS PLZ
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815-4251
Country	:	US
Telephone Number	:	562-597-3035
Fax Number	:	562-597-3055

Provider Business Practice Location Address
First Line	:	5214 E LOS ALTOS PLZ
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815-4251
Country	:	US
Telephone Number	:	562-597-3035
Fax Number	:	562-597-3055

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/04/2007
Last Update Date	:	01/04/2012

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Directions to “ KYLE FRED BALDWIN PT” Practice Location

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