Provider Demographics
NPI:1326787029
Name:BALDUCCI, ROBERT (DPT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:BALDUCCI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 W POPLAR AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-2578
Mailing Address - Country:US
Mailing Address - Phone:901-850-5246
Mailing Address - Fax:
Practice Address - Street 1:622 W POPLAR AVE STE 5
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-2578
Practice Address - Country:US
Practice Address - Phone:901-850-5246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14171225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist