Provider Demographics
NPI:1033899828
Name:BAKER, GARY A
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:A
Last Name:BAKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5346 TAMARACK TRL
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45331-9339
Mailing Address - Country:US
Mailing Address - Phone:937-467-6920
Mailing Address - Fax:
Practice Address - Street 1:7049 TAYLORSVILLE RD STE A
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-3190
Practice Address - Country:US
Practice Address - Phone:937-233-1755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty