Provider Demographics
NPI:1881032266
Name:BAKER, EMILY VIRGINIA (PT, DPT)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:VIRGINIA
Last Name:BAKER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 CENTRAL AVE
Mailing Address - Street 2:UNIT 1
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-3791
Mailing Address - Country:US
Mailing Address - Phone:843-970-7000
Mailing Address - Fax:843-970-7021
Practice Address - Street 1:911 CENTRAL AVE UNIT 1
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483
Practice Address - Country:US
Practice Address - Phone:843-970-7000
Practice Address - Fax:843-970-7021
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-07
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7044225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist