Provider Demographics
NPI:1831212620
Name:BAFFA, CORINNA RENE (PT)
Entity type:Individual
Prefix:MRS
First Name:CORINNA
Middle Name:RENE
Last Name:BAFFA
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 1:2604 HEDGEAPPLE DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76001
Mailing Address - Country:US
Mailing Address - Phone:817-466-2996
Mailing Address - Fax:940-627-7532
Practice Address - Street 1:2800 SOUTH FM 51
Practice Address - Street 2:SUITE B
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234
Practice Address - Country:US
Practice Address - Phone:940-627-7532
Practice Address - Fax:940-627-7547
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1137081225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX456779Medicare ID - Type Unspecified