Provider Demographics
NPI:1619462470
Name:BAKER, LAURA J (DPT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:J
Last Name:BAKER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 2ND ST
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:AK
Mailing Address - Zip Code:99824-5211
Mailing Address - Country:US
Mailing Address - Phone:907-419-7770
Mailing Address - Fax:
Practice Address - Street 1:1601 SALMON CREEK LN STE 1
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-7867
Practice Address - Country:US
Practice Address - Phone:907-419-7770
Practice Address - Fax:202-335-2034
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-25
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK130658225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist