Healthcare Provider Details

I. General information

NPI: 1659466704
Provider Name (Legal Business Name): JEFFREY BALDWIN A.S. PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18201 CONNEAUT LAKE RD
MEADVILLE PA
16335-3757
US

IV. Provider business mailing address

33791 E FREEMONT ST
TOWNVILLE PA
16360-2909
US

V. Phone/Fax

Practice location:
  • Phone: 814-333-5060
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTE007167
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: