Provider Demographics
NPI:1376673442
Name:BAKER, WILLIAM (LMT)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:BAKER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:MR
Other - First Name:BILL
Other - Middle Name:
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:1664 MCGREGOR AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-5757
Mailing Address - Country:US
Mailing Address - Phone:940-322-9090
Mailing Address - Fax:
Practice Address - Street 1:1664 MCGREGOR AVE
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-5757
Practice Address - Country:US
Practice Address - Phone:940-322-9090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMTO23087225700000X
TXMT023087172M00000X
MO2001007715172M00000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No172M00000XOther Service ProvidersMechanotherapist