Provider Demographics
NPI:1255304291
Name:BALDWIN, MARK CAMPBELL (PT, CSCS)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:CAMPBELL
Last Name:BALDWIN
Suffix:
Gender:M
Credentials:PT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 GREENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-4034
Mailing Address - Country:US
Mailing Address - Phone:508-596-8605
Mailing Address - Fax:
Practice Address - Street 1:7 ALFRED ST
Practice Address - Street 2:STE 110
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-1900
Practice Address - Country:US
Practice Address - Phone:508-596-8605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA113212251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports