=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407530371
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAYLIE RAE BAKER PT, DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2023
-----------------------------------------------------
Last Update Date | 01/29/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 795 WASHINGTON RD
-----------------------------------------------------
City | RYE
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03870-2318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 39-648-1446
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1466 TIMBER RD
-----------------------------------------------------
City | MANSFIELD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44905-2241
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-566-6108
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT020520
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT020520
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------