MEDICARE: JADA ANN NICOLE BAKER

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	2025030323	MO

General Provider Information

NPI Number	:	1639055395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JADA ANN NICOLE BAKER

Provider Business Mailing Address
First Line	:	2900 BARTOLD AVE APT 224
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63143-3610
Country	:	US
Telephone Number	:	618-920-0079
Fax Number	:

Provider Business Practice Location Address
First Line	:	2900 BARTOLD AVE APT 224
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63143-3610
Country	:	US
Telephone Number	:	618-920-0079
Fax Number	:

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

Provider Enumeration Date	:	08/15/2025
Last Update Date	:	08/15/2025

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Directions to “ JADA ANN NICOLE BAKER ” Practice Location

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