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General NPI Number Information
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NPI Number | 1669899001
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Entity Type | Individual
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Provider Name | CANAAN WYATT BAKER PTA/RD
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Gender | Male
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Dates
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Enumeration Date | 03/24/2014
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 3420 WHITEHURST RD
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City | GREENSBORO
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State | NC
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Zip | 27410-2580
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Country | US
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Telephone | 336-265-6731
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Fax |
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Provider Business Mailing Address
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Address Line | 3715 BOXWOOD CT
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City | THOMASVILLE
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State | NC
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Zip | 27360-7847
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Country | US
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Telephone | 336-609-2554
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 5266
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License Number State | NC
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