Healthcare Provider Details

I. General information

NPI: 1730468075
Provider Name (Legal Business Name): LENORE F BAKER L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2011
Last Update Date: 08/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 SE JOHNSON AVE SUITE 210
STUART FL
34994-3000
US

IV. Provider business mailing address

1618 SW BUFFUM LN
PORT SAINT LUCIE FL
34984-3530
US

V. Phone/Fax

Practice location:
  • Phone: 772-879-2609
  • Fax:
Mailing address:
  • Phone: 772-879-2609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA48592
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: