Individual
BRADY BAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1206 S 4TH ST, CHAMPAIGN, IL 61820-6953
(816) 548-9330
(217) 244-6854
Mailing address
1402 S 1ST ST, CHAMPAIGN, IL 61820-6916
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096.004281
IL
Other
Enumeration date
01/16/2018
Last updated
01/16/2018
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