Healthcare Provider Details

I. General information

NPI: 1467300616
Provider Name (Legal Business Name): MARY THERESA BAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2026
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7210 RUTHERFORD RD
WINDSOR MILL MD
21244-2719
US

IV. Provider business mailing address

4822 BARTHOLOW RD
SYKESVILLE MD
21784
US

V. Phone/Fax

Practice location:
  • Phone: 443-364-8182
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA6033
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: