Provider Demographics
NPI:1629404306
Name:BAINES, CELESTE M (MT)
Entity Type:Individual
Prefix:
First Name:CELESTE
Middle Name:M
Last Name:BAINES
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 MILTON ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-6527
Mailing Address - Country:US
Mailing Address - Phone:651-644-2787
Mailing Address - Fax:
Practice Address - Street 1:175 MILTON ST N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-6527
Practice Address - Country:US
Practice Address - Phone:651-644-2787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN862359OtherABMP