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General NPI Number Information
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NPI Number | 1952789539
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Entity Type | Individual
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Provider Name | TRACIE LAUREN BAKER LMT
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Gender | Female
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Dates
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Enumeration Date | 05/14/2015
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Last Update Date | 05/14/2015
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Provider Practice Location Address
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Address Line | 5620 EAST TEXAS RD
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City | EAST TEXAS (MACUNGIE)
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State | PA
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Zip | 18046
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Country | US
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Telephone | 610-398-7556
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Fax |
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Provider Business Mailing Address
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Address Line | 558 INTERCHANGE RD
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City | KRESGEVILLE
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State | PA
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Zip | 18333-7721
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Country | US
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Telephone | 570-688-7273
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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 | MSG003337
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License Number State | PA
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