MEDICARE: JEREMY BAKER

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	225100000X	Physical Therapist	PT012998	OH

General Provider Information

NPI Number	:	1114182821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMY BAKER

Provider Business Mailing Address
First Line	:	6006 MAHONING AVE
Second Line	:	SUITE 201
City	:	AUSTINTOWN
State	:	OH
Zip	:	44515-2239
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6006 MAHONING AVE
Second Line	:	SUITE 201
City	:	AUSTINTOWN
State	:	OH
Zip	:	44515-2239
Country	:	US
Telephone Number	:	330-755-3000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2008
Last Update Date	:	06/15/2021

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