Provider Demographics
NPI:1750382925
Name:BAKER, MARK ALLEN (DPT, OCS)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ALLEN
Last Name:BAKER
Suffix:
Gender:M
Credentials:DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-0099
Mailing Address - Country:US
Mailing Address - Phone:909-305-1383
Mailing Address - Fax:909-305-1435
Practice Address - Street 1:1335 W CYPRESS AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-3516
Practice Address - Country:US
Practice Address - Phone:909-305-1383
Practice Address - Fax:909-305-1435
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 14488225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA094711OtherHEALTHNET
CA21123014675OtherBEECHSTREET
CA827415OtherFIRST HEALTH AND CCN
CAPP3950OtherSAN GABRIEL REGIONAL CENT
CAZZZ01897ZOtherBLUE SHIELD OF CALIFORNIA
CA0004140895OtherAETNA
CA912124601OtherBLUE CROSS
CAPP3950OtherSAN GABRIEL REGIONAL CENT