Provider Demographics
NPI:1699073577
Name:BAKER, PAGE ALISA
Entity type:Individual
Prefix:MS
First Name:PAGE
Middle Name:ALISA
Last Name:BAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:PAGE
Other - Middle Name:ALISA
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT, LMT
Mailing Address - Street 1:374 8TH ST APT 1A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-3619
Mailing Address - Country:US
Mailing Address - Phone:917-941-3666
Mailing Address - Fax:
Practice Address - Street 1:374 8TH ST APT 1A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-3619
Practice Address - Country:US
Practice Address - Phone:917-941-3666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-02
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031351225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist