MEDICARE: COLLEEN BAXTER

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	225700000X	Massage Therapist	030393	NY

General Provider Information

NPI Number	:	1952886533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLEEN BAXTER

Provider Business Mailing Address
First Line	:	35 TREETOP DR
Second Line	:
City	:	FAIRPORT
State	:	NY
Zip	:	14450-3358
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	142 VILLAGE LNDG
Second Line	:
City	:	FAIRPORT
State	:	NY
Zip	:	14450-1804
Country	:	US
Telephone Number	:	585-346-1539
Fax Number	:

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

Provider Enumeration Date	:	09/28/2018
Last Update Date	:	09/28/2018

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Directions to “ COLLEEN BAXTER ” Practice Location

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