Provider Demographics
NPI:1710550959
Name:BAKER, REBECCA SUE (PT,DPT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:SUE
Last Name:BAKER
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
Other - First Name:BECCI
Other - Middle Name:SUE
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1070 S ROAD 10 W
Mailing Address - Street 2:
Mailing Address - City:HOXIE
Mailing Address - State:KS
Mailing Address - Zip Code:67740-4500
Mailing Address - Country:US
Mailing Address - Phone:402-360-2017
Mailing Address - Fax:
Practice Address - Street 1:720 MAIN STREET
Practice Address - Street 2:
Practice Address - City:HOXIE
Practice Address - State:KS
Practice Address - Zip Code:67740-6774
Practice Address - Country:US
Practice Address - Phone:402-360-2017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-05735225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist