Provider Demographics
NPI:1669899001
Name:BAKER, CANAAN WYATT (PTA/RD)
Entity type:Individual
Prefix:MR
First Name:CANAAN
Middle Name:WYATT
Last Name:BAKER
Suffix:
Gender:
Credentials:PTA/RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3715 BOXWOOD CT
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27360-7847
Mailing Address - Country:US
Mailing Address - Phone:336-609-2554
Mailing Address - Fax:
Practice Address - Street 1:3420 WHITEHURST RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-2580
Practice Address - Country:US
Practice Address - Phone:336-265-6731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-24
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5266225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant