Provider Demographics
NPI:1609486992
Name:BAKER, KRISTINE LAWRENCE (PT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:LAWRENCE
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 1:674 TACOMA DR
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-4744
Mailing Address - Country:US
Mailing Address - Phone:163-030-3269
Mailing Address - Fax:
Practice Address - Street 1:4058 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-5202
Practice Address - Country:US
Practice Address - Phone:630-793-4464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.005688225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist