Provider Demographics
NPI:1508069857
Name:BAKER, AMY JACQUELINE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:JACQUELINE
Last Name:BAKER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 SMITH ST
Mailing Address - Street 2:
Mailing Address - City:S DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02748-2321
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:225 ROCKLAND ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-3136
Practice Address - Country:US
Practice Address - Phone:508-999-4040
Practice Address - Fax:508-993-9387
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17194174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist