Provider Demographics
NPI:1578809174
Name:BAKER, MARJORIE POMEROY (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:MARJORIE
Middle Name:POMEROY
Last Name:BAKER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 MILLPOND RD
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-7407
Mailing Address - Country:US
Mailing Address - Phone:334-695-0993
Mailing Address - Fax:678-298-5640
Practice Address - Street 1:311 N DAWSON ST
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-5132
Practice Address - Country:US
Practice Address - Phone:334-695-0993
Practice Address - Fax:678-298-5640
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-31
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0109152251G0304X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003183884AMedicaid