=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033073614
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNIFER BAKER LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/09/2025
-----------------------------------------------------
Last Update Date | 12/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 150 ELDEN ST
-----------------------------------------------------
City | HERNDON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20170-4861
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-481-1808
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2634 BLACK FIR CT
-----------------------------------------------------
City | RESTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20191-4208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-677-1225
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 0019020445
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------