Provider Demographics
NPI:1588744874
Name:BAKER, SUE ANN (PT)
Entity type:Individual
Prefix:MRS
First Name:SUE
Middle Name:ANN
Last Name:BAKER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:SUE
Other - Middle Name:CARTER
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:20 DRAKE FARM RD
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-9388
Mailing Address - Country:US
Mailing Address - Phone:828-684-6656
Mailing Address - Fax:
Practice Address - Street 1:60 LIVINGSTON ST
Practice Address - Street 2:STE 400
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4402
Practice Address - Country:US
Practice Address - Phone:828-258-0797
Practice Address - Fax:828-258-5306
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1691225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211326Medicaid
NC650025316OtherRR MEDICARE
NC078KHOtherBLUE CROSS/BLUE SHIELD
NC7211326Medicaid