Provider Demographics
NPI:1366442352
Name:BAKSAY, STEPHEN (PT)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:BAKSAY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6397 LEE HWY
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2564
Mailing Address - Country:US
Mailing Address - Phone:423-238-3473
Mailing Address - Fax:
Practice Address - Street 1:7805 ABERCORN ST STE 21
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2457
Practice Address - Country:US
Practice Address - Phone:912-356-3559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-31
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACP011273T225100000X
OR2573225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR650017555OtherMEDICARE RAILROAD
ORJ284201OtherPACIFIC SOURCE INSURANCE
OR067873002OtherBLUE CROSS OF OREGON
OR182074Medicaid