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General NPI Number Information
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NPI Number | 1023863644
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Entity Type | Individual
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Provider Name | EBONY JEANETTE BAKER
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Gender | Female
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Dates
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Enumeration Date | 04/18/2024
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Last Update Date | 04/18/2024
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Provider Practice Location Address
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Address Line | 2329 S 57TH ST
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City | TEMPLE
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State | TX
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Zip | 76504-6957
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Country | US
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Telephone | 254-393-3036
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Fax |
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Provider Business Mailing Address
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Address Line | 202 WOODBRIDGE BLVD APT 278
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City | TEMPLE
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State | TX
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Zip | 76504-2134
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Country | US
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Telephone | 469-261-3899
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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