Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 11321 | MA |
NPI | 1255304291 |
---|---|
Provider Name | Mr. Mark Campbell Baldwin |
First Address | Wakefield, MA 01880-4034 |
Second Address | Woburn, MA 01801-1900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2006 |
Last Update Date | 05/02/2020 |