Provider Demographics
NPI:1902935943
Name:BALDUS, MARY JO (RMT)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:JO
Last Name:BALDUS
Suffix:
Gender:F
Credentials:RMT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:80 WARREN CT
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-1370
Mailing Address - Country:US
Mailing Address - Phone:507-453-9474
Mailing Address - Fax:507-457-1633
Practice Address - Street 1:80 WARREN CT
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-1370
Practice Address - Country:US
Practice Address - Phone:507-453-9474
Practice Address - Fax:507-457-1633
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD7613225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist