Provider Demographics
NPI:1407487325
Name:RICHARDSON BAKER, MICHELINA ELIZABETH (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:MICHELINA
Middle Name:ELIZABETH
Last Name:RICHARDSON BAKER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:MICHELINA
Other - Middle Name:ELIZABETH
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:11321 MALLORY SQUARE DR APT 304
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33635-6348
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10015 TRINITY BLVD STE 102
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-4589
Practice Address - Country:US
Practice Address - Phone:727-203-3760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-29
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305213687225100000X
FL34656225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist