Provider Demographics
NPI:1639266331
Name:BAKER, MADELEINE A (PT)
Entity Type:Individual
Prefix:MS
First Name:MADELEINE
Middle Name:A
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 1:1810 23RD ST
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77550-7904
Mailing Address - Country:US
Mailing Address - Phone:409-763-7025
Mailing Address - Fax:409-763-8648
Practice Address - Street 1:1810 23RD ST
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550-7904
Practice Address - Country:US
Practice Address - Phone:409-763-7025
Practice Address - Fax:409-763-8648
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1001030225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXBCBSOtherPROVIDER #
TX1001030OtherLICENSE #
TX1001030OtherLICENSE #
TX83653EMedicare ID - Type UnspecifiedINDIVIDUAL PROVIDER #