Provider Demographics
NPI:1306518725
Name:BAKER, AMANDA THERESE KLAAS (DPT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:THERESE KLAAS
Last Name:BAKER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4634 NE 78TH PL
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97218-4156
Mailing Address - Country:US
Mailing Address - Phone:360-972-8060
Mailing Address - Fax:
Practice Address - Street 1:801 NE HEARTHWOOD BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-7407
Practice Address - Country:US
Practice Address - Phone:360-604-6875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11782225100000X
OR62894225100000X
WAPT60905066225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist