Provider Demographics
NPI:1003097304
Name:BALDWIN, MARY A (PT)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:A
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2834
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22604-2034
Mailing Address - Country:US
Mailing Address - Phone:540-667-9137
Mailing Address - Fax:
Practice Address - Street 1:1515 CHAIN BRIDGE RD STE 104
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-4421
Practice Address - Country:US
Practice Address - Phone:703-356-7801
Practice Address - Fax:703-356-7814
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305004550225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAJ684-0004OtherBCBS
VAJ684-0004OtherBCBS
VAS68790Medicare UPIN