Provider Demographics
NPI:1669647517
Name:BALDWIN, SANDRA S (PTA)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:S
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4605 VALDRES SPRINGS CT
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WI
Mailing Address - Zip Code:54476-4189
Mailing Address - Country:US
Mailing Address - Phone:715-393-0400
Mailing Address - Fax:715-393-0435
Practice Address - Street 1:4605 VALDRES SPRINGS CT
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WI
Practice Address - Zip Code:54476-4189
Practice Address - Country:US
Practice Address - Phone:715-393-0400
Practice Address - Fax:715-393-0435
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI446-019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant