Provider Demographics
NPI:1548428154
Name:BAKER, LYNN ELLEN MARIE (PTA)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:ELLEN MARIE
Last Name:BAKER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7540 N 19TH AVE
Mailing Address - Street 2:STE#200
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-7967
Mailing Address - Country:US
Mailing Address - Phone:888-873-4221
Mailing Address - Fax:888-543-2289
Practice Address - Street 1:100 VETERANS PKWY
Practice Address - Street 2:STE # 100A
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311-7003
Practice Address - Country:US
Practice Address - Phone:760-252-6757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT 508225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant