Healthcare Provider Details

I. General information

NPI: 1609196849
Provider Name (Legal Business Name): ROBERT BAKER PT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 06/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

362 LAKE FOREST RD
ROCHESTER HLS MI
48309-2234
US

IV. Provider business mailing address

362 LAKE FOREST RD
ROCHESTER HLS MI
48309-2234
US

V. Phone/Fax

Practice location:
  • Phone: 248-961-1020
  • Fax:
Mailing address:
  • Phone: 248-961-1020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501001380
License Number StateMI

VIII. Authorized Official

Name: ROBERT BAKER
Title or Position: OWNER
Credential: PT
Phone: 248-961-1020