Provider Demographics
NPI:1083634422
Name:BAKER, JOEY (PT)
Entity Type:Individual
Prefix:
First Name:JOEY
Middle Name:
Last Name:BAKER
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 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-446-5244
Mailing Address - Fax:740-446-5448
Practice Address - Street 1:1051 4TH AVE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631
Practice Address - Country:US
Practice Address - Phone:740-446-5244
Practice Address - Fax:740-446-5448
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH011312225100000X
WV2516225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2666637Medicaid
310917085167OtherOH MEDICAID - CARESOURCE
OH000000204400OtherOH MEDICAID UNISON
001796085OtherMOUNTAIN STATE BCBS
OH2666637OtherMOLINA MEDICAID
000000217253OtherANTHEM BCBS
P00328954OtherRR MEDICARE
WV3810004328Medicaid
001796085OtherMOUNTAIN STATE BCBS