Provider Demographics
NPI:1750368742
Name:BAKER, KATY C (PT)
Entity type:Individual
Prefix:MRS
First Name:KATY
Middle Name:C
Last Name:BAKER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 SAMMY MCGHEE BLVD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-7703
Mailing Address - Country:US
Mailing Address - Phone:706-253-6287
Mailing Address - Fax:706-253-6289
Practice Address - Street 1:91 SAMMY MCGHEE BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-7703
Practice Address - Country:US
Practice Address - Phone:706-253-6287
Practice Address - Fax:706-253-6289
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT005450225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA65BBCZQMedicare ID - Type Unspecified
GAP78487Medicare UPIN