Healthcare Provider Details

I. General information

NPI: 1265358493
Provider Name (Legal Business Name): ELIAS ANDREW BAEDER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 GARFIELD AVE
CARMICHAEL CA
95608-6647
US

IV. Provider business mailing address

7328 GRAND OAKS BLVD
CITRUS HEIGHTS CA
95621-1255
US

V. Phone/Fax

Practice location:
  • Phone: 916-481-6455
  • Fax:
Mailing address:
  • Phone: 916-410-3533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: