Provider Demographics
NPI:1366442352
Name:BAKSAY, STEPHEN (PT)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:BAKSAY
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 1:2780 E BARNETT RD STE 200
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8674
Mailing Address - Country:US
Mailing Address - Phone:541-779-6250
Mailing Address - Fax:
Practice Address - Street 1:2780 E BARNETT RD STE 200
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8674
Practice Address - Country:US
Practice Address - Phone:541-779-6250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-31
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2573225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR067873002OtherBLUE CROSS OF OREGON
OR182074Medicaid
OR650017555OtherMEDICARE RAILROAD
ORJ284201OtherPACIFIC SOURCE INSURANCE