Provider Demographics
NPI:1649439415
Name:BALDWIN, DWAYNE GRANT (PTA)
Entity type:Individual
Prefix:MR
First Name:DWAYNE
Middle Name:GRANT
Last Name:BALDWIN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7521 11TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98106-2023
Mailing Address - Country:US
Mailing Address - Phone:206-933-1084
Mailing Address - Fax:
Practice Address - Street 1:7521 11TH AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98106-2023
Practice Address - Country:US
Practice Address - Phone:206-933-1084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant