Provider Demographics
NPI:1194710962
Name:BAKER, CHRISTOPHER E (LPT, DIP MDT)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:E
Last Name:BAKER
Suffix:
Gender:M
Credentials:LPT, DIP MDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2626 JBS PARKWAY
Mailing Address - Street 2:B101
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-1958
Mailing Address - Country:US
Mailing Address - Phone:432-550-0422
Mailing Address - Fax:432-550-4463
Practice Address - Street 1:2626 JBS PARKWAY
Practice Address - Street 2:B101
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-1958
Practice Address - Country:US
Practice Address - Phone:432-550-0422
Practice Address - Fax:432-550-4463
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1015725225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX062991702Medicaid
TX83462TOtherBLUE CROSS BLUE SHIELD
TX650171Medicare PIN