Provider Demographics
NPI:1851541874
Name:BAKER, MARTIN (ATC)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:
Last Name:BAKER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 ARBOR DR
Mailing Address - Street 2:
Mailing Address - City:ELON
Mailing Address - State:NC
Mailing Address - Zip Code:27244-9100
Mailing Address - Country:US
Mailing Address - Phone:336-278-6800
Mailing Address - Fax:336-278-6767
Practice Address - Street 1:2500 CAMPUS BOX
Practice Address - Street 2:ELON UNIVERSITY AT DEPARTMENT
Practice Address - City:ELON
Practice Address - State:NC
Practice Address - Zip Code:27244
Practice Address - Country:US
Practice Address - Phone:336-278-6800
Practice Address - Fax:336-278-6767
Is Sole Proprietor?:No
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC03362255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNC0336OtherSTATE LICENSE