Provider Demographics
NPI:1619088978
Name:BALDWIN, JENNIFER (RPT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 CAINHOY LANDING RD
Mailing Address - Street 2:
Mailing Address - City:WANDO
Mailing Address - State:SC
Mailing Address - Zip Code:29492-7801
Mailing Address - Country:US
Mailing Address - Phone:843-442-7232
Mailing Address - Fax:843-881-4001
Practice Address - Street 1:116 CAINHOY LANDING RD
Practice Address - Street 2:
Practice Address - City:WANDO
Practice Address - State:SC
Practice Address - Zip Code:29492-7801
Practice Address - Country:US
Practice Address - Phone:843-442-7232
Practice Address - Fax:843-881-4001
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC31672251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH1208Medicaid