Provider Demographics
NPI:1588682959
Name:BAKER, SHELLEY D (PT)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:D
Last Name:BAKER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2603 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:NEEDVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77461-8436
Mailing Address - Country:US
Mailing Address - Phone:979-793-6453
Mailing Address - Fax:281-344-8926
Practice Address - Street 1:1500 JACKSON ST.
Practice Address - Street 2:400
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-8436
Practice Address - Country:US
Practice Address - Phone:281-344-8900
Practice Address - Fax:281-344-8926
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1111474174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist