Provider Demographics
NPI:1003882655
Name:BAIRD, CHARLES (PT)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:
Last Name:BAIRD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5111 SW 94TH ST.
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608
Mailing Address - Country:US
Mailing Address - Phone:727-326-5104
Mailing Address - Fax:727-819-8362
Practice Address - Street 1:5111 SW 94TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608
Practice Address - Country:US
Practice Address - Phone:727-326-5104
Practice Address - Fax:727-819-8362
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT5442225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT5442Medicare ID - Type UnspecifiedPHYSICAL THERAPY