Healthcare Provider Details

I. General information

NPI: 1114836251
Provider Name (Legal Business Name): BRET DANIEL BAKER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2167 NW 185TH AVE
HILLSBORO OR
97124-7074
US

IV. Provider business mailing address

11505 SW JODY ST
BEAVERTON OR
97005-1541
US

V. Phone/Fax

Practice location:
  • Phone: 503-828-1311
  • Fax:
Mailing address:
  • Phone: 503-621-7868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number29895
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: