Individual
LUCAS BAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
943 MAPLE DR, MORGANTOWN, WV 26505-2812
(304) 599-2515
Mailing address
5466 IRADELL RD, ITHACA, NY 14850-9257
(607) 387-5893
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2000028601
WV
Other
Enumeration date
03/19/2019
Last updated
03/19/2019
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