Provider Demographics
NPI:1861547028
Name:BAKER, SHAWNA DEANN (ATC)
Entity type:Individual
Prefix:MISS
First Name:SHAWNA
Middle Name:DEANN
Last Name:BAKER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4452 MENTONE ST UNIT 105
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92107-1062
Mailing Address - Country:US
Mailing Address - Phone:619-294-9757
Mailing Address - Fax:
Practice Address - Street 1:2100 GREENFIELD DRIVE
Practice Address - Street 2:KINESIOLOGY ATHLETICS
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-1161
Practice Address - Country:US
Practice Address - Phone:619-441-2200
Practice Address - Fax:619-590-1734
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist