Provider Demographics
NPI:1396779443
Name:BAKER, ROBERT LESLIE (PT)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:LESLIE
Last Name:BAKER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1137 ESSEX ST
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-5538
Mailing Address - Country:US
Mailing Address - Phone:415-847-7147
Mailing Address - Fax:925-399-6587
Practice Address - Street 1:239 MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-8220
Practice Address - Country:US
Practice Address - Phone:415-847-7147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT13568225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA043667600OtherCORPORATE TAX ID
CAOPT135680Medicare ID - Type UnspecifiedPPIN