MEDICARE: BAKER PHYSICAL THERAPY PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1033618483
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAKER PHYSICAL THERAPY PC

Provider Business Mailing Address
First Line	:	6712 YELLOWSTONE BLVD APT D19
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-2350
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6712 YELLOWSTONE BLVD APT D19
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-2350
Country	:	US
Telephone Number	:	347-531-6234
Fax Number	:

Authorized Official
Title or Position	:	PT
Name	:	RUKAIYA BAKER
Credential	:
Telephone Number	:	347-531-6234

Provider Enumeration Date	:	02/12/2018
Last Update Date	:	02/12/2018

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