Provider Demographics
NPI:1245268317
Name:BAAS, DONALD ROY (PT)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:ROY
Last Name:BAAS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 493396
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96049-3396
Mailing Address - Country:US
Mailing Address - Phone:530-221-9952
Mailing Address - Fax:530-221-9954
Practice Address - Street 1:5061 SHASTA DAM BLVD
Practice Address - Street 2:
Practice Address - City:SHASTA LAKE
Practice Address - State:CA
Practice Address - Zip Code:96019-9422
Practice Address - Country:US
Practice Address - Phone:530-275-0777
Practice Address - Fax:530-275-8779
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT17148225100000X
WAPT00006688225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7115371Medicaid
WAG8857201Medicare ID - Type UnspecifiedMEDICARE NUMBER
WA7115371Medicaid