Individual
KEVIN BAERWALDE
Active
Individual
KEVIN BAERWALDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
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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