Provider Demographics
NPI:1770666554
Name:BAKER, PAMELA ANNE (PT)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:ANNE
Last Name:BAKER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4601 66TH STREET
Mailing Address - Street 2:SUITE D
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79414-4828
Mailing Address - Country:US
Mailing Address - Phone:806-793-3900
Mailing Address - Fax:806-793-3937
Practice Address - Street 1:4601 66TH STREET
Practice Address - Street 2:SUITE D
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79414-4828
Practice Address - Country:US
Practice Address - Phone:806-793-3900
Practice Address - Fax:806-793-3937
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-08-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX10538902251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84433TOtherBLUE CROSS BLUE SHIELD