Provider Demographics
NPI:1043021942
Name:BAKER, DEBRA RENEE (DPT)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:RENEE
Last Name:BAKER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535B RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:66548-9140
Mailing Address - Country:US
Mailing Address - Phone:785-562-7148
Mailing Address - Fax:
Practice Address - Street 1:708 N 18TH ST
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:KS
Practice Address - Zip Code:66508-1338
Practice Address - Country:US
Practice Address - Phone:785-562-4480
Practice Address - Fax:785-562-5465
Is Sole Proprietor?:No
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-03750225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist