Provider Demographics
NPI:1457009102
Name:BAKER, LAUREN DANIELLE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:DANIELLE
Last Name:BAKER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 ROBERTSON WAY
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:MS
Mailing Address - Zip Code:38632-2261
Mailing Address - Country:US
Mailing Address - Phone:901-734-3307
Mailing Address - Fax:
Practice Address - Street 1:1314 PEABODY AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3500
Practice Address - Country:US
Practice Address - Phone:901-321-5803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-11
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS6257225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist