MEDICARE: MRS. STEPHANIE BOREN BAKER PT

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		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PT17963	OTHER	FL	LICENSE NUMBER

General Provider Information

NPI Number	:	1134221641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHANIE BOREN BAKER PT

Provider Business Mailing Address
First Line	:	956 INTERNATIONAL PKWY STE 1580
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-5219
Country	:	US
Telephone Number	:	407-936-0314
Fax Number	:	407-936-0316

Provider Business Practice Location Address
First Line	:	956 INTERNATIONAL PKWY STE 1580
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-5219
Country	:	US
Telephone Number	:	407-936-0314
Fax Number	:	407-936-0316

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

Provider Enumeration Date	:	09/04/2006
Last Update Date	:	04/03/2023

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