Provider Demographics
NPI:1295772358
Name:BALDRY, JOLYN RANAE (PT)
Entity type:Individual
Prefix:MS
First Name:JOLYN
Middle Name:RANAE
Last Name:BALDRY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:JOLYN
Other - Middle Name:RANAE
Other - Last Name:RICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1419 GREENE ST
Mailing Address - Street 2:
Mailing Address - City:FT ATKINSON
Mailing Address - State:WI
Mailing Address - Zip Code:53538
Mailing Address - Country:US
Mailing Address - Phone:920-568-8662
Mailing Address - Fax:
Practice Address - Street 1:1550 MADISON AVE STE 102
Practice Address - Street 2:
Practice Address - City:FT ATKINSON
Practice Address - State:WI
Practice Address - Zip Code:53538
Practice Address - Country:US
Practice Address - Phone:920-568-9739
Practice Address - Fax:920-568-9742
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9983024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist