Provider Demographics
NPI:1003523804
Name:BALTODANO, ERIC BLAINE (DPT)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:BLAINE
Last Name:BALTODANO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13215 GRANT RD STE 900
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-4094
Mailing Address - Country:US
Mailing Address - Phone:832-220-9211
Mailing Address - Fax:832-610-2354
Practice Address - Street 1:13215 GRANT RD STE 900
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-4094
Practice Address - Country:US
Practice Address - Phone:832-220-9211
Practice Address - Fax:832-610-2354
Is Sole Proprietor?:No
Enumeration Date:2022-11-01
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1329120225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist