Provider Demographics
NPI:1609045368
Name:BAKER, MARY ELLEN (PT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELLEN
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 1:93 COUNTY ROUTE 19
Mailing Address - Street 2:PO BOX 36
Mailing Address - City:LIVINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12541-0036
Mailing Address - Country:US
Mailing Address - Phone:518-851-6084
Mailing Address - Fax:518-851-6084
Practice Address - Street 1:93 COUNTY ROUTE 19
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12541-0036
Practice Address - Country:US
Practice Address - Phone:518-851-6084
Practice Address - Fax:518-851-6084
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3287225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist