Provider Demographics
NPI:1831665835
Name:BAKER, KYLE STEVEN (PT DPT)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:STEVEN
Last Name:BAKER
Suffix:
Gender:M
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:COUDERSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:16915-8161
Mailing Address - Country:US
Mailing Address - Phone:814-274-5300
Mailing Address - Fax:
Practice Address - Street 1:1001 E MAIN ST STE 510
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701-3273
Practice Address - Country:US
Practice Address - Phone:814-596-0016
Practice Address - Fax:814-596-0024
Is Sole Proprietor?:No
Enumeration Date:2018-10-17
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT027407225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist