Provider Demographics
NPI:1760028443
Name:BALDWIN, TAYLOR MARIE
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:MARIE
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 8TH ST # 48
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-4266
Mailing Address - Country:US
Mailing Address - Phone:509-597-7077
Mailing Address - Fax:
Practice Address - Street 1:2525 8TH ST # 48
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-4266
Practice Address - Country:US
Practice Address - Phone:509-597-7077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-18
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMAST-3986225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist