Provider Demographics
NPI:1508977182
Name:BAKER, JAMIE GRAHAM (PT)
Entity Type:Individual
Prefix:MR
First Name:JAMIE
Middle Name:GRAHAM
Last Name:BAKER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:447458 E 110 RD
Mailing Address - Street 2:
Mailing Address - City:BLUEJACKET
Mailing Address - State:OK
Mailing Address - Zip Code:74333-4351
Mailing Address - Country:US
Mailing Address - Phone:918-541-0419
Mailing Address - Fax:918-540-7739
Practice Address - Street 1:310 2ND AVE SW
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-6743
Practice Address - Country:US
Practice Address - Phone:918-540-7738
Practice Address - Fax:918-540-7739
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1671225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist