Provider Demographics
NPI:1801957568
Name:BALDWIN, SHERI LYNETTE (PT)
Entity type:Individual
Prefix:MRS
First Name:SHERI
Middle Name:LYNETTE
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 EMPRESA DRIVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2820
Mailing Address - Country:US
Mailing Address - Phone:805-783-2390
Mailing Address - Fax:805-783-2402
Practice Address - Street 1:3421 EMPRESA DR
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-7364
Practice Address - Country:US
Practice Address - Phone:805-783-2390
Practice Address - Fax:805-783-2402
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT17498225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT174980OtherBLUE SHIELD PROVIDER NUMB
CAPT0174980Medicaid
CAPT0174980OtherRAIL ROAD MEDICARE NUMBER
CAPT0174980Medicaid