Provider Demographics
NPI:1285783613
Name:BAIKIE, BOBBI ELLEN (PTA, ATC)
Entity type:Individual
Prefix:
First Name:BOBBI
Middle Name:ELLEN
Last Name:BAIKIE
Suffix:
Gender:F
Credentials:PTA, ATC
Other - Prefix:
Other - First Name:BOBBI
Other - Middle Name:ELLEN
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA, ATC
Mailing Address - Street 1:2008 WINDCREST LN
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60431-8793
Mailing Address - Country:US
Mailing Address - Phone:815-782-7649
Mailing Address - Fax:
Practice Address - Street 1:17837 80TH AVE
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-5023
Practice Address - Country:US
Practice Address - Phone:708-342-2500
Practice Address - Fax:708-342-1454
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2008-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225200000X, 2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer