Provider Demographics
NPI:1801534540
Name:BALDOVINO, JOHN KEVIN SALCEDO (PTA, PT)
Entity type:Individual
Prefix:MR
First Name:JOHN KEVIN
Middle Name:SALCEDO
Last Name:BALDOVINO
Suffix:
Gender:M
Credentials:PTA, PT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2427 85TH ST # 2F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-3503
Mailing Address - Country:US
Mailing Address - Phone:347-944-8273
Mailing Address - Fax:
Practice Address - Street 1:1345 AVENUE OF THE AMERICAS FL 11
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10105-0013
Practice Address - Country:US
Practice Address - Phone:212-981-1977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013258225200000X
NY042947225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant