MEDICARE: MRS. SALLY ANN BAKER PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	0530	NH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205900768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SALLY ANN BAKER PT

Provider Business Mailing Address
First Line	:	331 PACKERS FALLS ROAD
Second Line	:
City	:	DURHAM
State	:	NH
Zip	:	03824-4404
Country	:	US
Telephone Number	:	603-868-1900
Fax Number	:	603-868-1900

Provider Business Practice Location Address
First Line	:	331 PACKERS FALLS ROAD
Second Line	:
City	:	DURHAM
State	:	NH
Zip	:	03824-4404
Country	:	US
Telephone Number	:	603-868-1900
Fax Number	:	603-868-1900

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	07/08/2007

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