MEDICARE: KEITH BALDONADO

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	225200000X	Physical Therapy Assistant	A-0473	NV

General Provider Information

NPI Number	:	1972896132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEITH BALDONADO

Provider Business Mailing Address
First Line	:	2116 MOUNTAIN GLOW AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-4377
Country	:	US
Telephone Number	:	702-321-6344
Fax Number	:

Provider Business Practice Location Address
First Line	:	2116 MOUNTAIN GLOW AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-4377
Country	:	US
Telephone Number	:	702-321-6344
Fax Number	:

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

Provider Enumeration Date	:	05/20/2011
Last Update Date	:	05/20/2011

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Directions to “ KEITH BALDONADO ” Practice Location

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