Provider Demographics
NPI:1124531629
Name:BAXENDELL, DYLAN JON (MS, LAT, ATC)
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:JON
Last Name:BAXENDELL
Suffix:
Gender:M
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:376 SARATOGA DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15236-4455
Mailing Address - Country:US
Mailing Address - Phone:412-992-0936
Mailing Address - Fax:
Practice Address - Street 1:450 SCHOOLHOUSE RD
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-2912
Practice Address - Country:US
Practice Address - Phone:412-992-0936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-07
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0061952255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer