Provider Demographics
NPI:1689188013
Name:BAKER, CHRISTY CAROLINE (PTA)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:CAROLINE
Last Name:BAKER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4445 EASTGATE MALL STE 410
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1979
Mailing Address - Country:US
Mailing Address - Phone:858-622-9266
Mailing Address - Fax:
Practice Address - Street 1:4445 EASTGATE MALL STE 410
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1979
Practice Address - Country:US
Practice Address - Phone:858-622-9266
Practice Address - Fax:858-622-9266
Is Sole Proprietor?:No
Enumeration Date:2017-11-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPTA48903225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant