Provider Demographics
NPI:1790560258
Name:BAKER, SYBIL W
Entity Type:Individual
Prefix:
First Name:SYBIL
Middle Name:W
Last Name:BAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4616 KENNY RD STE B4
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2705
Mailing Address - Country:US
Mailing Address - Phone:614-580-8218
Mailing Address - Fax:
Practice Address - Street 1:48 E NORTH BROADWAY ST RM 321
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-4112
Practice Address - Country:US
Practice Address - Phone:614-580-8218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.006787225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist