Healthcare Provider Details

I. General information

NPI: 1891731964
Provider Name (Legal Business Name): TIMOTHY L BAKER R.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 W ROUTE 66 STE N
GLENDORA CA
91740-4164
US

IV. Provider business mailing address

PO BOX 866308
PLANO TX
75086-6308
US

V. Phone/Fax

Practice location:
  • Phone: 626-335-4077
  • Fax:
Mailing address:
  • Phone:
  • Fax: 717-635-4785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT305272
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: