Provider Demographics
NPI:1649558982
Name:BAKER, ASHLEY C (DPT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:C
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 1:3439 SE HAWTHORNE BLVD # 504
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-5048
Mailing Address - Country:US
Mailing Address - Phone:419-565-2555
Mailing Address - Fax:
Practice Address - Street 1:3439 SE HAWTHORNE BLVD # 504
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-5048
Practice Address - Country:US
Practice Address - Phone:419-565-2555
Practice Address - Fax:877-635-1840
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-03
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC871260225100000X
VA2305206989225100000X
OR64056225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG02816Medicare PIN
DC226944YT9Medicare PIN