Provider Demographics
NPI:1235565417
Name:BALDEO, KEVIN N (PT)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:N
Last Name:BALDEO
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 1:27 LOIS ST
Mailing Address - Street 2:FORMULA PHYSICAL THERAPY, CORP
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-4404
Mailing Address - Country:US
Mailing Address - Phone:203-642-3813
Mailing Address - Fax:203-642-3815
Practice Address - Street 1:27 LOIS ST
Practice Address - Street 2:FORMULA PHYSICAL THERAPY, CORP
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-4404
Practice Address - Country:US
Practice Address - Phone:203-642-3813
Practice Address - Fax:203-642-3815
Is Sole Proprietor?:No
Enumeration Date:2013-09-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT03649180225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist