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NPI Code Detail

MEDICARE: MISS AIMEE CARRON BAKER PT

MEDICARE: MISS AIMEE CARRON 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
1225100000XPhysical Therapist5501002616MI

General Provider Information

NPI Number : 1417575135
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS AIMEE CARRON BAKER PT
Provider Business Mailing Address
First Line : 9596 DOLORES
Second Line :
City : CLARKSTON
State : MI
Zip : 48348-2400
Country : US
Telephone Number : 248-891-8445
Fax Number :
Provider Business Practice Location Address
First Line : 1120 E LONG LAKE RD STE 201
Second Line :
City : TROY
State : MI
Zip : 48085-4716
Country : US
Telephone Number : 248-496-0098
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/09/2020
Last Update Date : 07/09/2020

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Directions to “ MISS AIMEE CARRON BAKER PT” Practice Location

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