Provider Demographics
NPI:1417079880
Name:BALDWIN, MARCI DENISE (PTA)
Entity Type:Individual
Prefix:
First Name:MARCI
Middle Name:DENISE
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:MARCI
Other - Middle Name:DENISE
Other - Last Name:MORIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:14165 NW 66TH CT
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64152-5255
Mailing Address - Country:US
Mailing Address - Phone:816-880-3731
Mailing Address - Fax:
Practice Address - Street 1:10300 W 103RD ST
Practice Address - Street 2:SUITE 300
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66214-2642
Practice Address - Country:US
Practice Address - Phone:913-894-1910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1401200225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO116592OtherSTATE LICENSE
KS14-01200OtherSTATE LICENSE