Provider Demographics
NPI:1376658013
Name:BAKER, SALLY SUE (LMP)
Entity Type:Individual
Prefix:MS
First Name:SALLY
Middle Name:SUE
Last Name:BAKER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 522
Mailing Address - Street 2:
Mailing Address - City:BLACK DIAMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98010
Mailing Address - Country:US
Mailing Address - Phone:425-412-1718
Mailing Address - Fax:425-413-1035
Practice Address - Street 1:23862 SE KENT KANGLEY
Practice Address - Street 2:C/O PARTAIN CHIROPRACTIC
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038
Practice Address - Country:US
Practice Address - Phone:425-413-1718
Practice Address - Fax:425-413-1035
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00003060225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WABA8484OtherREGENCE INS