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Individual

KEVIN BAERWALDE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PT

Contact information

Practice address
302 S GREENWOOD ST, LAGRANGE, GA 30240-3122
(706) 884-8360
(706) 884-0265
Mailing address
302 S GREENWOOD ST, LAGRANGE, GA 30240-3122
(706) 884-8360
(706) 884-0265

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
LIC006138
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
112003
BCBS-FITNESS FORUM
GA
01
393730
BCBS OF GA
GA
01
52793122-002
BCBS ID NUMBER
GA
01
611446156001
TRICARE-FITNESS FORUM
GA
01
65BBCKQ
MEDICARE PIN-FITNESS FORUM
GA
Enumeration date
09/23/2005
Last updated
06/09/2008
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