MEDICARE: VALECIA ANN BALDWIN-JOHNSON NCMT/RN

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	172M00000X	Mechanotherapist	4716	SC

General Provider Information

NPI Number	:	1326294901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALECIA ANN BALDWIN-JOHNSON NCMT/RN

Provider Business Mailing Address
First Line	:	455 RAST STREET
Second Line	:
City	:	SUMTER
State	:	SC
Zip	:	29150-2579
Country	:	US
Telephone Number	:	803-774-4772
Fax Number	:

Provider Business Practice Location Address
First Line	:	455 RAST STREET
Second Line	:
City	:	SUMTER
State	:	SC
Zip	:	29150-2579
Country	:	US
Telephone Number	:	803-774-4772
Fax Number	:

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

Provider Enumeration Date	:	08/14/2008
Last Update Date	:	08/14/2008

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Directions to “ VALECIA ANN BALDWIN-JOHNSON NCMT/RN” Practice Location

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