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General NPI Number Information
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NPI Number | 1902259336
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Entity Type | Individual
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Provider Name | REBECCA BALDRIDGE PTA
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Gender | Female
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Dates
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Enumeration Date | 07/20/2016
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Last Update Date | 07/20/2016
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Provider Practice Location Address
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Address Line | 721 W MULBERRY ST
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City | ANGLETON
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State | TX
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Zip | 77515-4239
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Country | US
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Telephone | 979-848-0279
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Fax |
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Provider Business Mailing Address
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Address Line | 504 CENTER WAY ST
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City | LAKE JACKSON
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State | TX
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Zip | 77566-5404
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2124296
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License Number State | TX
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