MEDICARE: MR. ROBERT DARRELL BAUGHN P.T.

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	225100000X	Physical Therapist	R62985	AL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	650015260	OTHER	AL	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699752600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT DARRELL BAUGHN P.T.

Provider Business Mailing Address
First Line	:	2980 HIGHWAY 78 E
Second Line	:
City	:	JASPER
State	:	AL
Zip	:	35501-8903
Country	:	US
Telephone Number	:	205-384-1941
Fax Number	:

Provider Business Practice Location Address
First Line	:	2980 HIGHWAY 78 E
Second Line	:
City	:	JASPER
State	:	AL
Zip	:	35501-8903
Country	:	US
Telephone Number	:	205-384-1941
Fax Number	:	205-384-6362

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

Provider Enumeration Date	:	12/30/2005
Last Update Date	:	11/30/2010

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