Marycarol Baker, PT, CKTP, CCI
Individual provider Active NPI Physical Therapist · Juneau, AK
NPI 1265747414 · NPPES record last updated Jul 19, 2012
Key facts
- NPI
- 1265747414
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 2004025487 (MO)
- Practice address
- 210 Ferry Way
Juneau, AK 99801-1389 - Phone
- (314) 541-7902
- Fax
- (573) 803-0742
- NPI assigned
- Aug 12, 2010
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPT-344 | ID | MD | Physical Therapist |
| 070003083 | IL | MD | Physical Therapist |
| 2004025487 | MO | MD | Physical Therapist |
| P13507 | NC | MD | Physical Therapist |
| 2398 | AK | MD | Physician Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 2004025487 | MO | Yes |
| Physical Therapist | 225100000X | 2398 | AK | |
| Physical Therapist | 225100000X | RPT-344 | ID | |
| Physical Therapist | 225100000X | 070003083 | IL | |
| Physical Therapist | 225100000X | P13507 | NC |
Addresses
Primary practice location
210 Ferry Way
Juneau, AK 99801-1389
Mailing address
1556 Lexington Ave
Cape Girardeau, MO 63701-2528
Phone (314) 541-7902
Other providers in Juneau, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 19, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.