MEDICARE: LOLA BAKER LMT

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	225700000X	Massage Therapist	MA104183	FL

General Provider Information

NPI Number	:	1164291894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOLA BAKER LMT

Provider Business Mailing Address
First Line	:	112 HOBSON AVE
Second Line	:
City	:	CRESTVIEW
State	:	FL
Zip	:	32539-6767
Country	:	US
Telephone Number	:	305-336-8536
Fax Number	:

Provider Business Practice Location Address
First Line	:	3076 GULF BREEZE PKWY
Second Line	:
City	:	GULF BREEZE
State	:	FL
Zip	:	32563-3246
Country	:	US
Telephone Number	:	305-336-8536
Fax Number	:

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

Provider Enumeration Date	:	12/21/2023
Last Update Date	:	12/22/2023

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Directions to “ LOLA BAKER LMT” Practice Location

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