Provider Demographics
NPI:1215216452
Name:BAKER, JEFFREY LYNN (PTA)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:LYNN
Last Name:BAKER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2124 S 113TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-3030
Mailing Address - Country:US
Mailing Address - Phone:402-933-0293
Mailing Address - Fax:
Practice Address - Street 1:5505 GROVER ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-3718
Practice Address - Country:US
Practice Address - Phone:402-558-0225
Practice Address - Fax:402-558-0227
Is Sole Proprietor?:No
Enumeration Date:2011-08-05
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE462225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant