Healthcare Provider Details

I. General information

NPI: 1518361765
Provider Name (Legal Business Name): PATRICK C BAKER LMP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 10/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9015 HOLMAN RD NW SUITE 3
SEATTLE WA
98117-3481
US

IV. Provider business mailing address

9015 HOLMAN RD NW SUITE 3
SEATTLE WA
98117-3481
US

V. Phone/Fax

Practice location:
  • Phone: 425-773-1065
  • Fax: 206-784-4020
Mailing address:
  • Phone: 425-773-1065
  • Fax: 206-784-4020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00018968
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: