Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 5501002736 | MI |
Y | 2251N0400X | Physical Therapist - Neurology | 5501002736 | MI |
NPI | 1073982641 |
---|---|
Provider Name | Barbara Baker |
First Address | Grand Rapids, MI 49506-4304 |
Second Address | Grand Rapids, MI 49506-4304 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2015 |
Last Update Date | 19/01/2017 |