Provider Demographics
NPI:1356695910
Name:BALDWIN, VICTORIA WOOD (DPT)
Entity type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:WOOD
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 YELLOW JACKET DR
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-3736
Mailing Address - Country:US
Mailing Address - Phone:662-338-5439
Mailing Address - Fax:
Practice Address - Street 1:610 YELLOW JACKET DR
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-3736
Practice Address - Country:US
Practice Address - Phone:662-338-5439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT51802251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics