Provider Demographics
NPI:1043412679
Name:BALDWIN PHYSICAL THERAPY INC.
Entity Type:Organization
Organization Name:BALDWIN PHYSICAL THERAPY INC.
Other - Org Name:CENTER FOR PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:FRED
Authorized Official - Last Name:BALDWIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:562-597-3035
Mailing Address - Street 1:5214 E LOS ALTOS PLZ
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-4251
Mailing Address - Country:US
Mailing Address - Phone:562-597-3035
Mailing Address - Fax:562-597-3055
Practice Address - Street 1:5214 E LOS ALTOS PLZ
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-4251
Practice Address - Country:US
Practice Address - Phone:562-597-3035
Practice Address - Fax:562-597-3055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 19105225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT19105Medicare ID - Type UnspecifiedPHYSICAL THERAPY PROVIDER