Provider Demographics
NPI:1912496753
Name:BAKER, TREVOR JOHN (PT, DPT, GCS)
Entity Type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:JOHN
Last Name:BAKER
Suffix:
Gender:M
Credentials:PT, DPT, GCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3463 E 3890 N
Mailing Address - Street 2:
Mailing Address - City:KIMBERLY
Mailing Address - State:ID
Mailing Address - Zip Code:83341-5508
Mailing Address - Country:US
Mailing Address - Phone:208-644-0693
Mailing Address - Fax:208-231-8628
Practice Address - Street 1:3463 E 3890 N
Practice Address - Street 2:
Practice Address - City:KIMBERLY
Practice Address - State:ID
Practice Address - Zip Code:83341-5508
Practice Address - Country:US
Practice Address - Phone:208-644-0693
Practice Address - Fax:208-231-8628
Is Sole Proprietor?:No
Enumeration Date:2018-05-08
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-4500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist