Provider Demographics
NPI:1871774968
Name:BAKER, TIRSA ESCALANTE (PT)
Entity type:Individual
Prefix:
First Name:TIRSA
Middle Name:ESCALANTE
Last Name:BAKER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10664 E PORTOBELLO AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-1842
Mailing Address - Country:US
Mailing Address - Phone:480-907-4876
Mailing Address - Fax:480-380-1748
Practice Address - Street 1:10664 E PORTOBELLO AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-1842
Practice Address - Country:US
Practice Address - Phone:480-907-4876
Practice Address - Fax:480-380-1748
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-17
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7855225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist