Provider Demographics
NPI:1144590217
Name:BAKER, KYLE ANDRE JULIO (LMT)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:ANDRE JULIO
Last Name:BAKER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11239 PEARTREE WAY
Mailing Address - Street 2:APT. I
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-4342
Mailing Address - Country:US
Mailing Address - Phone:443-253-6383
Mailing Address - Fax:443-864-4633
Practice Address - Street 1:11239 PEARTREE WAY
Practice Address - Street 2:APT. I
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-4342
Practice Address - Country:US
Practice Address - Phone:443-253-6383
Practice Address - Fax:443-864-4633
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMT1343225700000X
MDR01515225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02109549OtherADVENTIST RISK MGMT, INC.