Healthcare Provider Details

I. General information

NPI: 1326108374
Provider Name (Legal Business Name): CHARLES B. BARKER III DPT, OCS, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 11/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 S GOVERNORS AVE
DOVER DE
19904-6901
US

IV. Provider business mailing address

1015 S GOVERNORS AVE
DOVER DE
19904-6901
US

V. Phone/Fax

Practice location:
  • Phone: 302-730-4800
  • Fax: 302-730-8040
Mailing address:
  • Phone: 302-730-4800
  • Fax: 302-730-8040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ1-0000614
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: