Provider Demographics
NPI:1417575135
Name:BAKER, AIMEE CARRON (PT)
Entity Type:Individual
Prefix:MISS
First Name:AIMEE
Middle Name:CARRON
Last Name:BAKER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:AIMEE
Other - Middle Name:MARIE
Other - Last Name:CARRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:9596 DOLORES
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48348-2400
Mailing Address - Country:US
Mailing Address - Phone:248-891-8445
Mailing Address - Fax:
Practice Address - Street 1:1120 E LONG LAKE RD STE 201
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-4716
Practice Address - Country:US
Practice Address - Phone:248-496-0098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501002616225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist