Provider Demographics
NPI:1093951899
Name:BAKER, TIMOTHY LOELL (PTA)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:LOELL
Last Name:BAKER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4560 SE INTERNATIONAL WAY, STE. 100
Mailing Address - Street 2:CONSONUS HEALTHCARE SERVICES ATTN: ANNA BROWNE
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222
Mailing Address - Country:US
Mailing Address - Phone:971-206-5200
Mailing Address - Fax:971-206-5209
Practice Address - Street 1:1649 E 72ND ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98404
Practice Address - Country:US
Practice Address - Phone:971-206-5200
Practice Address - Fax:971-206-5209
Is Sole Proprietor?:No
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP160045517225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant