Provider Demographics
NPI:1952645400
Name:BAKER, JAMIE LEIGH (PTA)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LEIGH
Last Name:BAKER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6130 RIVERWOODS DR
Mailing Address - Street 2:108
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-2868
Mailing Address - Country:US
Mailing Address - Phone:740-236-2330
Mailing Address - Fax:
Practice Address - Street 1:631 JUNCTION CREEK DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-2296
Practice Address - Country:US
Practice Address - Phone:910-442-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-23
Last Update Date:2012-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4769225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant