Healthcare Provider Details

I. General information

NPI: 1538286497
Provider Name (Legal Business Name): BRENDA MARIE BARBER PTA LICENSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1731 DR FRANK GASTON BLVD
ROCK HILL SC
29732-1190
US

IV. Provider business mailing address

9802 MITCHELL GLEN DR
CHARLOTTE NC
28277-6605
US

V. Phone/Fax

Practice location:
  • Phone: 803-329-6865
  • Fax:
Mailing address:
  • Phone: 704-287-1398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1844
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number3311
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: