Provider Demographics
NPI:1730211699
Name:BAKER, JIMMIE B JR (PT)
Entity type:Individual
Prefix:MR
First Name:JIMMIE
Middle Name:B
Last Name:BAKER
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11308 FIRENZE LN
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91326-4194
Mailing Address - Country:US
Mailing Address - Phone:818-886-8090
Mailing Address - Fax:
Practice Address - Street 1:11308 FIRENZE LN
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91326-4194
Practice Address - Country:US
Practice Address - Phone:818-257-1917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 23997225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist