Healthcare Provider Details

I. General information

NPI: 1174586234
Provider Name (Legal Business Name): GRETCHEN ELIZABETH BAKER-BOLD MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETSY BAKER

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 RUCKER AVE STE 100
EVERETT WA
98201-2879
US

IV. Provider business mailing address

214 ALVERSON BLVD
EVERETT WA
98201-1004
US

V. Phone/Fax

Practice location:
  • Phone: 425-268-0412
  • Fax:
Mailing address:
  • Phone: 425-268-0412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00007077
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License NumberPT00007077
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT00007077
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT00007077
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: