Healthcare Provider Details

I. General information

NPI: 1396077327
Provider Name (Legal Business Name): ADRIAN L. BAKER D.P.T
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2010
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 LATHAM DR
WARNER ROBINS GA
31088-2146
US

IV. Provider business mailing address

405 OSIGIAN BLVD
WARNER ROBINS GA
31088-8958
US

V. Phone/Fax

Practice location:
  • Phone: 478-887-3141
  • Fax:
Mailing address:
  • Phone: 478-953-3535
  • Fax: 478-953-0353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9855
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: