Provider Demographics
NPI:1497227052
Name:BAAS, JOHN CLARENCE BERIN (PT)
Entity Type:Individual
Prefix:MR
First Name:JOHN CLARENCE
Middle Name:BERIN
Last Name:BAAS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 MANSFIELD RD APT 109
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-3179
Mailing Address - Country:US
Mailing Address - Phone:571-447-7066
Mailing Address - Fax:
Practice Address - Street 1:999 ORONOQUE LN FL 1
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-1379
Practice Address - Country:US
Practice Address - Phone:203-870-2022
Practice Address - Fax:203-386-1144
Is Sole Proprietor?:No
Enumeration Date:2018-12-20
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11723225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist