Provider Demographics
NPI:1871840744
Name:BAKER, ALYSIA RHAE (MS, PT)
Entity Type:Individual
Prefix:
First Name:ALYSIA
Middle Name:RHAE
Last Name:BAKER
Suffix:
Gender:F
Credentials:MS, PT
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:815 N LARKIN AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-3438
Mailing Address - Country:US
Mailing Address - Phone:815-730-1800
Mailing Address - Fax:
Practice Address - Street 1:1715 DEKALB AVE
Practice Address - Street 2:SUITE 125
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-2736
Practice Address - Country:US
Practice Address - Phone:815-991-5760
Practice Address - Fax:815-991-5766
Is Sole Proprietor?:No
Enumeration Date:2012-08-10
Last Update Date:2012-08-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL070010027225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist