Provider Demographics
NPI:1124175484
Name:BAKER, JOANNA RUTH (PT LMHC)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:RUTH
Last Name:BAKER
Suffix:
Gender:F
Credentials:PT LMHC
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:RUTH
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT LMHC
Mailing Address - Street 1:4370 S TAMIAMI TRL
Mailing Address - Street 2:SUITE 241
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-3412
Mailing Address - Country:US
Mailing Address - Phone:941-926-2474
Mailing Address - Fax:941-926-2440
Practice Address - Street 1:4370 S TAMIAMI TRL
Practice Address - Street 2:SUITE 241
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-3412
Practice Address - Country:US
Practice Address - Phone:941-926-2474
Practice Address - Fax:941-926-2440
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4720101YM0800X
FLPT13914225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL833687000OtherMAGELLAN
FL833687000OtherMAGELLAN