Provider Demographics
NPI:1205900768
Name:BAKER, SALLY ANN (PT)
Entity type:Individual
Prefix:MRS
First Name:SALLY ANN
Middle Name:
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 1:331 PACKERS FALLS ROAD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03824-4404
Mailing Address - Country:US
Mailing Address - Phone:603-868-1900
Mailing Address - Fax:603-868-1900
Practice Address - Street 1:331 PACKERS FALLS ROAD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NH
Practice Address - Zip Code:03824-4404
Practice Address - Country:US
Practice Address - Phone:603-868-1900
Practice Address - Fax:603-868-1900
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0530225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30003487Medicaid
RE1394Medicare UPIN
NH30003487Medicaid