Healthcare Provider Details

I. General information

NPI: 1366819542
Provider Name (Legal Business Name): JACQUELYN BARRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2015
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7581 HIGHWAY 98 WEST
PENSACOLA FL
32506
US

IV. Provider business mailing address

7581 HIGHWAY 98 WEST
PENSACOLA FL
32506
US

V. Phone/Fax

Practice location:
  • Phone: 850-453-9475
  • Fax: 850-453-9673
Mailing address:
  • Phone: 301-870-7366
  • Fax: 301-870-6717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number25637
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT38440
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: