Healthcare Provider Details

I. General information

NPI: 1316256621
Provider Name (Legal Business Name): BARBARA BARGES PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2010
Last Update Date: 10/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3226 S 112TH ST
OMAHA NE
68144-4708
US

IV. Provider business mailing address

3226 S 112TH ST
OMAHA NE
68144-4708
US

V. Phone/Fax

Practice location:
  • Phone: 402-672-6794
  • Fax:
Mailing address:
  • Phone: 402-672-6794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number875
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: