Healthcare Provider Details

I. General information

NPI: 1932300282
Provider Name (Legal Business Name): JEFFREY RAYMOND BAREFOOT PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 CHIPMAN WAY
KINGSTON MA
02364-1039
US

IV. Provider business mailing address

25 FORGE RD
ASSONET MA
02702-1428
US

V. Phone/Fax

Practice location:
  • Phone: 781-585-4100
  • Fax:
Mailing address:
  • Phone: 781-585-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number7697
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: