Basic Information
| Provider Information | |||||||||
| NPI: | 1881898906 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BALDWIN | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 676 DEKALB PIKE | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | BLUE BELL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194221223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102700370 | ||||||||
| FaxNumber: | 6102700374 | ||||||||
| Practice Location | |||||||||
| Address1: | 780 WEST LINCOLN HIGHWAY | ||||||||
| Address2: | THE COMMONS AT OAKLANDS | ||||||||
| City: | EXTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108734856 | ||||||||
| FaxNumber: | 6108734859 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT000688E | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | PT000688E | 01 | PA | PT LICENSE | OTHER |