Healthcare Provider Details

I. General information

NPI: 1942775929
Provider Name (Legal Business Name): EDNA SONYA BARRETT DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2018
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 W FOOTHILL BLVD STE 100
RIALTO CA
92376-4731
US

IV. Provider business mailing address

25852 LOMAS VERDES ST
REDLANDS CA
92373-8404
US

V. Phone/Fax

Practice location:
  • Phone: 909-850-4222
  • Fax:
Mailing address:
  • Phone: 909-754-0683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number293373
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number293373
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: