Healthcare Provider Details

I. General information

NPI: 1053983767
Provider Name (Legal Business Name): MADISON A BAKER PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2021
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4179 LINDELL BLVD
SAINT LOUIS MO
63108-2913
US

IV. Provider business mailing address

2122 YORK RD STE 300
OAK BROOK IL
60523-1925
US

V. Phone/Fax

Practice location:
  • Phone: 314-944-0494
  • Fax:
Mailing address:
  • Phone: 630-575-1980
  • Fax: 630-928-5080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2021033578
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: