Provider Demographics
NPI:1265619639
Name:BAKER, AMY NICOLE (DPT)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:NICOLE
Last Name:BAKER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:234 WEST ST S
Mailing Address - Street 2:SOUTHVIEW PLAZA SUITE #4
Mailing Address - City:GRINNELL
Mailing Address - State:IA
Mailing Address - Zip Code:50112-8160
Mailing Address - Country:US
Mailing Address - Phone:641-236-4506
Mailing Address - Fax:641-236-4316
Practice Address - Street 1:234 WEST ST S
Practice Address - Street 2:SOUTHVIEW PLAZA SUITE #4
Practice Address - City:GRINNELL
Practice Address - State:IA
Practice Address - Zip Code:50112-8160
Practice Address - Country:US
Practice Address - Phone:641-236-4506
Practice Address - Fax:641-236-4316
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004152225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0461624Medicaid
IA71749OtherBCBS
IAI14912 001Medicare PIN