Healthcare Provider Details

I. General information

NPI: 1902152333
Provider Name (Legal Business Name): JANET ELAINE BARKER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2012
Last Update Date: 08/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 SAINT MARYS DR
EDWARDSVILLE IL
62025-4276
US

IV. Provider business mailing address

3801 OLD BRUCEVILLE RD
VINCENNES IN
47591-3889
US

V. Phone/Fax

Practice location:
  • Phone: 618-692-1330
  • Fax:
Mailing address:
  • Phone: 812-886-4677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number160.004259
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: