Provider Demographics
NPI:1578509121
Name:BALDESSARI, OSVALDO (PT)
Entity Type:Individual
Prefix:MR
First Name:OSVALDO
Middle Name:
Last Name:BALDESSARI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:OS
Other - Middle Name:
Other - Last Name:BALDESSARI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 40189
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-0189
Mailing Address - Country:US
Mailing Address - Phone:303-884-3118
Mailing Address - Fax:
Practice Address - Street 1:1660 S ALBION ST
Practice Address - Street 2:SUITE 1001
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4008
Practice Address - Country:US
Practice Address - Phone:303-884-3118
Practice Address - Fax:303-862-8221
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7314225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO805038Medicare UPIN