Healthcare Provider Details

I. General information

NPI: 1649435488
Provider Name (Legal Business Name): KRISTEN JOLENE BARBOUR DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2008
Last Update Date: 07/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8308 HAMPSHIRE BAY ST
LAS VEGAS NV
89139-6830
US

IV. Provider business mailing address

8308 HAMPSHIRE BAY ST
LAS VEGAS NV
89139-6830
US

V. Phone/Fax

Practice location:
  • Phone: 716-984-8237
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number2014
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: