Provider Demographics
NPI:1083133532
Name:BALDWIN, LAKEN NICOLLE (DPT)
Entity Type:Individual
Prefix:
First Name:LAKEN
Middle Name:NICOLLE
Last Name:BALDWIN
Suffix:
Gender:F
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:PO BOX 671
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72811-0671
Mailing Address - Country:US
Mailing Address - Phone:479-970-2008
Mailing Address - Fax:
Practice Address - Street 1:1703 WEST MAIN STREET SUITE A
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-7280
Practice Address - Country:US
Practice Address - Phone:479-970-2008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-15
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4364225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist