Provider Demographics
NPI:1336296334
Name:BAUGHMAN, MARK HENRY (PT ATC)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:HENRY
Last Name:BAUGHMAN
Suffix:
Gender:M
Credentials:PT ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2370 3RD ST S
Mailing Address - Street 2:SUITE 2
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-4023
Mailing Address - Country:US
Mailing Address - Phone:904-853-5106
Mailing Address - Fax:904-853-5107
Practice Address - Street 1:2370 3RD ST S
Practice Address - Street 2:SUITE 2
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-4023
Practice Address - Country:US
Practice Address - Phone:904-853-5106
Practice Address - Fax:904-853-5107
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT21322225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015235500Medicaid