Provider Demographics
NPI:1366152027
Name:BAKER, NAIYA (PT, DPT)
Entity type:Individual
Prefix:
First Name:NAIYA
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3460 RUNNYMEADE DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-2673
Mailing Address - Country:US
Mailing Address - Phone:678-708-5868
Mailing Address - Fax:
Practice Address - Street 1:3460 RUNNYMEADE DR
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-2673
Practice Address - Country:US
Practice Address - Phone:678-708-5868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-02
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCCP019162T225100000X
GAPT016290225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist