Provider Demographics
NPI:1285926733
Name:BALDWIN-SOARES, TAMARA FAITH
Entity type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:FAITH
Last Name:BALDWIN-SOARES
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:TAMARA
Other - Middle Name:FAITH
Other - Last Name:BALDWIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:900 VIA LUGANO CIRCLE
Mailing Address - Street 2:UNIT 203
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436
Mailing Address - Country:US
Mailing Address - Phone:561-703-0393
Mailing Address - Fax:
Practice Address - Street 1:1815 S FEDERAL HWY #15
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435
Practice Address - Country:US
Practice Address - Phone:561-703-0393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA39989225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist