MEDICARE: MARK ALLEN BAKER D.P.T., O.C.S.

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	PT 14488	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	094711	OTHER	CA	HEALTHNET
2	21123014675	OTHER	CA	BEECHSTREET
3	827415	OTHER	CA	FIRST HEALTH AND CCN
4	PP3950	OTHER	CA	SAN GABRIEL REGIONAL CENT
5	ZZZ01897Z	OTHER	CA	BLUE SHIELD OF CALIFORNIA
6	0004140895	OTHER	CA	AETNA
7	912124601	OTHER	CA	BLUE CROSS

General Provider Information

NPI Number	:	1750382925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK ALLEN BAKER D.P.T., O.C.S.

Provider Business Mailing Address
First Line	:	PO BOX 99
Second Line	:
City	:	SAN DIMAS
State	:	CA
Zip	:	91773-0099
Country	:	US
Telephone Number	:	909-305-1383
Fax Number	:	909-305-1435

Provider Business Practice Location Address
First Line	:	1335 W CYPRESS AVE
Second Line	:	SUITE 100
City	:	SAN DIMAS
State	:	CA
Zip	:	91773-3516
Country	:	US
Telephone Number	:	909-305-1383
Fax Number	:	909-305-1435

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	08/23/2022

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Directions to “ MARK ALLEN BAKER D.P.T., O.C.S.” Practice Location

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