Provider Demographics
NPI:1821466889
Name:BALDWIN, VINCENT WAYNE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:WAYNE
Last Name:BALDWIN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15742 W WATSON LN
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-5603
Mailing Address - Country:US
Mailing Address - Phone:801-472-9970
Mailing Address - Fax:
Practice Address - Street 1:19303 N NEW TRADITION RD
Practice Address - Street 2:
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-3806
Practice Address - Country:US
Practice Address - Phone:623-547-5088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-08
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11027225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist