Provider Demographics
NPI:1730468075
Name:BAKER, LENORE F (LMT)
Entity Type:Individual
Prefix:MRS
First Name:LENORE
Middle Name:F
Last Name:BAKER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1618 SW BUFFUM LN
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-3530
Mailing Address - Country:US
Mailing Address - Phone:772-879-2609
Mailing Address - Fax:
Practice Address - Street 1:851 SE JOHNSON AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-3000
Practice Address - Country:US
Practice Address - Phone:772-879-2609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA48592225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist