Provider Demographics
NPI:1184653594
Name:BAKER, SUZANNE CLANTON (PT)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:CLANTON
Last Name:BAKER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2708 GRAND NATIONAL PKWY
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-1661
Mailing Address - Country:US
Mailing Address - Phone:334-705-8906
Mailing Address - Fax:
Practice Address - Street 1:30 SAMFORD AVE
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-3146
Practice Address - Country:US
Practice Address - Phone:334-742-9266
Practice Address - Fax:334-742-0818
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH1272225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000075008Medicare PIN