Provider Demographics
NPI:1962930222
Name:BALDWIN, MATTHEW D (DPT)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:D
Last Name:BALDWIN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 S COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-5304
Mailing Address - Country:US
Mailing Address - Phone:405-422-1291
Mailing Address - Fax:405-422-1294
Practice Address - Street 1:1300 S COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-5304
Practice Address - Country:US
Practice Address - Phone:405-422-1291
Practice Address - Fax:405-422-1294
Is Sole Proprietor?:No
Enumeration Date:2017-05-31
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4258225100000X
NM5061225100000X
UT7275450-2401225100000X
OK5331225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM24953563Medicaid