Provider Demographics
NPI:1518927599
Name:BAKER, DARLA SUE (PT ATC L)
Entity Type:Individual
Prefix:MISS
First Name:DARLA
Middle Name:SUE
Last Name:BAKER
Suffix:
Gender:F
Credentials:PT ATC L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7701 W KILGORE AVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:YORKTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47396-9290
Mailing Address - Country:US
Mailing Address - Phone:765-759-5273
Mailing Address - Fax:765-759-5519
Practice Address - Street 1:7701 W KILGORE AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:YORKTOWN
Practice Address - State:IN
Practice Address - Zip Code:47396-9290
Practice Address - Country:US
Practice Address - Phone:765-759-5273
Practice Address - Fax:765-759-5519
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05004997A225100000X
IN36000446A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer