Healthcare Provider Details

I. General information

NPI: 1205855202
Provider Name (Legal Business Name): JEFFERY D. BALDWIN P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 8TH ST SUITE A
RUPERT ID
83350-1527
US

IV. Provider business mailing address

385 S HIGHWAY 27
BURLEY ID
83318-5704
US

V. Phone/Fax

Practice location:
  • Phone: 208-436-9016
  • Fax: 208-436-4922
Mailing address:
  • Phone: 208-678-2405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-1466
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: