Healthcare Provider Details

I. General information

NPI: 1356635155
Provider Name (Legal Business Name): LAUREN JORDAE BAKER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN JORDAE GRIMES

II. Dates (important events)

Enumeration Date: 06/09/2011
Last Update Date: 06/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 THOMAS JOHNSON CT # B
FREDERICK MD
21702-4348
US

IV. Provider business mailing address

2498 WAYSIDE CT
FREDERICK MD
21702-2630
US

V. Phone/Fax

Practice location:
  • Phone: 301-662-8541
  • Fax: 301-662-8762
Mailing address:
  • Phone: 301-662-8541
  • Fax: 301-662-8762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number23656
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: