Individual
MR. MICHAEL VON BAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC,SCAT
Contact information
Practice address
18818 ASHEVILLE HWY, CAMPOBELLO, SC 29322
(864) 457-2606
Mailing address
PO BOX 609, LANDRUM, SC 29356
(864) 457-2606
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
331
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
331
STATE LICENSE NUMBER
SC
Enumeration date
10/16/2006
Last updated
07/08/2007
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