Provider Demographics
NPI:1134499254
Name:BALDWIN, JEFFREY (CMT, RMT)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:
Last Name:BALDWIN
Suffix:
Gender:M
Credentials:CMT, RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5125 S COLLEGE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3959
Mailing Address - Country:US
Mailing Address - Phone:303-319-4325
Mailing Address - Fax:
Practice Address - Street 1:5125 S COLLEGE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3959
Practice Address - Country:US
Practice Address - Phone:303-319-4325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT-12693225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist