Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 2305004550 | VA |
NPI | 1003097304 |
---|---|
Provider Name | Ms. Mary A. Baldwin |
First Address | Winchester, VA 22604-2034 |
Second Address | Mc Lean, VA 22101-4421 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2007 |
Last Update Date | 16/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
J684-0004 | BCBS (01) | VA |
S68790 | (02) | VA |