Provider Demographics
NPI:1255462164
Name:BALDWIN, LAUREN CORREALE (PTA)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:CORREALE
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 1:447 S BARRINGTON CT
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-2163
Mailing Address - Country:US
Mailing Address - Phone:570-956-9110
Mailing Address - Fax:
Practice Address - Street 1:1707 FOULK RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-2733
Practice Address - Country:US
Practice Address - Phone:302-479-0880
Practice Address - Fax:302-479-0550
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant