Provider Demographics
NPI:1376633172
Name:BAKKER, CHRISTINA (PT, MBA)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:BAKKER
Suffix:
Gender:F
Credentials:PT, MBA
Other - Prefix:
Other - First Name:KARIEN
Other - Middle Name:
Other - Last Name:BAKKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT, MBA
Mailing Address - Street 1:W370S10733 SHEARER RD
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:WI
Mailing Address - Zip Code:53119-1762
Mailing Address - Country:US
Mailing Address - Phone:262-844-1254
Mailing Address - Fax:
Practice Address - Street 1:W370S10733 SHEARER RD
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:WI
Practice Address - Zip Code:53119-1762
Practice Address - Country:US
Practice Address - Phone:262-844-1254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4730-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40385100Medicaid
WI83424-0004Medicare ID - Type Unspecified