Provider Demographics
NPI:1356635155
Name:BAKER, LAUREN JORDAE (DPT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:JORDAE
Last Name:BAKER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:JORDAE
Other - Last Name:GRIMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2498 WAYSIDE CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-2630
Mailing Address - Country:US
Mailing Address - Phone:301-662-8541
Mailing Address - Fax:301-662-8762
Practice Address - Street 1:84 THOMAS JOHNSON CT # B
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4348
Practice Address - Country:US
Practice Address - Phone:301-662-8541
Practice Address - Fax:301-662-8762
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD236562251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD551810OtherMAMSI
MD2004876OtherUNITED HEALTHCARE