Provider Demographics
NPI:1487368080
Name:JONATHAN BAKER ENTERPRISES, LLC
Entity type:Organization
Organization Name:JONATHAN BAKER ENTERPRISES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:540-309-3734
Mailing Address - Street 1:1316 W G ST STE 2
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-2898
Mailing Address - Country:US
Mailing Address - Phone:423-297-1037
Mailing Address - Fax:
Practice Address - Street 1:1316 W G ST STE 2
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-2898
Practice Address - Country:US
Practice Address - Phone:423-297-1037
Practice Address - Fax:423-297-1038
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOVEWORKS PHYSICAL THERAPY & SEMINARS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-01-09
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy