Provider Demographics
NPI:1326294901
Name:BALDWIN-JOHNSON, VALECIA ANN (NCMT/RN)
Entity Type:Individual
Prefix:
First Name:VALECIA
Middle Name:ANN
Last Name:BALDWIN-JOHNSON
Suffix:
Gender:F
Credentials:NCMT/RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 RAST STREET
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-2579
Mailing Address - Country:US
Mailing Address - Phone:803-774-4772
Mailing Address - Fax:
Practice Address - Street 1:455 RAST STREET
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-2579
Practice Address - Country:US
Practice Address - Phone:803-774-4772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4716172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist