Healthcare Provider Details

I. General information

NPI: 1497896005
Provider Name (Legal Business Name): TAMARA L BAKER RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10001 NE 1ST ST APT W313
BELLEVUE WA
98004-5670
US

IV. Provider business mailing address

1100 BELLEVUE WAY NE STE 8A856
BELLEVUE WA
98004-4280
US

V. Phone/Fax

Practice location:
  • Phone: 425-890-3989
  • Fax:
Mailing address:
  • Phone: 425-890-3989
  • Fax: 425-881-2312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00003899
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT0003899
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: