=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144945544
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BG MEDICAL, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2022
-----------------------------------------------------
Last Update Date | 10/07/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 239 MAIN ST STE B
-----------------------------------------------------
City | PLEASANTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94566-8220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-847-7147
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | ROBERT BAKER 1137 ESSEX ST
-----------------------------------------------------
City | LIVERMORE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94550-5538
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-847-7147
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ROBERT LESLIE BAKER
-----------------------------------------------------
Credential | PT, PHD, MBA, OCS
-----------------------------------------------------
Telephone | 415-847-7147
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------