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NPI Code Detail

MEDICARE: MRS. SANDRA S BALDWIN PTA

MEDICARE: MRS. SANDRA S BALDWIN PTA
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
1225200000XPhysical Therapy Assistant446-019WI

General Provider Information

NPI Number : 1669647517
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SANDRA S BALDWIN PTA
Provider Business Mailing Address
First Line : 4605 VALDRES SPRINGS CT
Second Line :
City : WESTON
State : WI
Zip : 54476-4189
Country : US
Telephone Number : 715-393-0400
Fax Number : 715-393-0435
Provider Business Practice Location Address
First Line : 4605 VALDRES SPRINGS CT
Second Line :
City : WESTON
State : WI
Zip : 54476-4189
Country : US
Telephone Number : 715-393-0400
Fax Number : 715-393-0435
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/22/2008
Last Update Date : 10/05/2010

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