Provider Demographics
NPI:1942207899
Name:BAUM, TINA LYNN (PT, ATC, CLT)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:LYNN
Last Name:BAUM
Suffix:
Gender:F
Credentials:PT, ATC, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34797
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-4797
Mailing Address - Country:US
Mailing Address - Phone:702-877-2000
Mailing Address - Fax:702-877-2100
Practice Address - Street 1:7250 PEAK DR
Practice Address - Street 2:SUITE 118
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-9027
Practice Address - Country:US
Practice Address - Phone:702-877-2000
Practice Address - Fax:702-877-2100
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1204225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCC2342OtherBLUE CROSS BLUE SHIELD
NV37727Medicare ID - Type Unspecified
NVCC2342OtherBLUE CROSS BLUE SHIELD