Healthcare Provider Details

I. General information

NPI: 1497041743
Provider Name (Legal Business Name): DANIEL BAKER ATC, LAT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2011
Last Update Date: 06/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6286 BRIARCREST AVE # 110
MEMPHIS TN
38120-4023
US

IV. Provider business mailing address

6286 BRIARCREST AVE # 110
MEMPHIS TN
38120-4023
US

V. Phone/Fax

Practice location:
  • Phone: 901-259-1600
  • Fax:
Mailing address:
  • Phone: 901-259-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2000003568
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: