Provider Demographics
NPI:1134221641
Name:BAKER, STEPHANIE BOREN (PT)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:BOREN
Last Name:BAKER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:956 INTERNATIONAL PKWY STE 1580
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-5219
Mailing Address - Country:US
Mailing Address - Phone:407-936-0314
Mailing Address - Fax:407-936-0316
Practice Address - Street 1:956 INTERNATIONAL PKWY STE 1580
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-5219
Practice Address - Country:US
Practice Address - Phone:407-936-0314
Practice Address - Fax:407-936-0316
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT17963OtherLICENSE NUMBER