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NPI Code Detail

MEDICARE: GRAY BAKER PT, DPT

MEDICARE: GRAY BAKER PT, DPT
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
1225100000XPhysical TherapistPT38343FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1285389627
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRAY BAKER PT, DPT
Provider Business Mailing Address
First Line : 1402 SE 16TH PL
Second Line :
City : CAPE CORAL
State : FL
Zip : 33990-3819
Country : US
Telephone Number : 239-321-4652
Fax Number :
Provider Business Practice Location Address
First Line : 1402 SE 16TH PL
Second Line :
City : CAPE CORAL
State : FL
Zip : 33990-3819
Country : US
Telephone Number : 239-772-2363
Fax Number : 239-772-2365
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2022
Last Update Date : 02/15/2022

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