Basic Information
| Provider Information | |||||||||
| NPI: | 1619256393 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAKER | ||||||||
| FirstName: | BRADY | ||||||||
| MiddleName: | DANIEL | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5584 | ||||||||
| Address2: | |||||||||
| City: | FRISCO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 804435584 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703686054 | ||||||||
| FaxNumber: | 8645285701 | ||||||||
| Practice Location | |||||||||
| Address1: | 1143 CAPITOL STREET | ||||||||
| Address2: | UNIT 102B | ||||||||
| City: | EAGLE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 81631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703068609 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2011 | ||||||||
| LastUpdateDate: | 08/11/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 6581 | CO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.