Healthcare Provider Details

I. General information

NPI: 1225104904
Provider Name (Legal Business Name): WILLIAM R BARNES JR. PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 01/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 E GUADALUPE RD
TEMPE AZ
85283-3273
US

IV. Provider business mailing address

1855 E GUADALUPE RD
TEMPE AZ
85283-3273
US

V. Phone/Fax

Practice location:
  • Phone: 480-839-8552
  • Fax: 480-752-7978
Mailing address:
  • Phone: 480-839-8552
  • Fax: 480-752-7978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA1988
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberP160197428
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: