Provider Demographics
NPI:1194998328
Name:BAKER, JODI LYN (MPT)
Entity type:Individual
Prefix:MS
First Name:JODI
Middle Name:LYN
Last Name:BAKER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6860 MAGNOLIA PARK LN
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-3149
Mailing Address - Country:US
Mailing Address - Phone:404-992-7300
Mailing Address - Fax:
Practice Address - Street 1:12587 SPRING HILL DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-5068
Practice Address - Country:US
Practice Address - Phone:352-686-4344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT23731225100000X
GAPT006653225100000X
NC10954225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist