Provider Demographics
NPI:1578387916
Name:BALDOWSKI, NICHOLE MARIE (LMT)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:MARIE
Last Name:BALDOWSKI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3825 RAVENWOOD PL
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-5227
Mailing Address - Country:US
Mailing Address - Phone:941-993-8763
Mailing Address - Fax:
Practice Address - Street 1:3825 RAVENWOOD PL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-5227
Practice Address - Country:US
Practice Address - Phone:941-993-8763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL76753225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist