Provider Demographics
NPI:1114278512
Name:BAKER, JONATHAN DOUGLAS (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:DOUGLAS
Last Name:BAKER
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 W G ST STE 2
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-2898
Mailing Address - Country:US
Mailing Address - Phone:423-297-1037
Mailing Address - Fax:423-297-1038
Practice Address - Street 1:1316 W G ST STE 2
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-2898
Practice Address - Country:US
Practice Address - Phone:423-297-1037
Practice Address - Fax:423-297-1038
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-25
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
9188261QP2000X
TN9188225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6008485OtherBLUE CROSS BLUE SHIELD TN
TN4336765Medicaid