Healthcare Provider Details

I. General information

NPI: 1396728713
Provider Name (Legal Business Name): MATTHEW JAMES BARNES DPT, ATC/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 04/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2412 W ANDREW JOHNSON HWY
MORRISTOWN TN
37814-3276
US

IV. Provider business mailing address

2259 SANDSTONE DR
MORRISTOWN TN
37814-2593
US

V. Phone/Fax

Practice location:
  • Phone: 423-317-9699
  • Fax: 423-317-9225
Mailing address:
  • Phone: 423-317-9699
  • Fax: 423-317-9225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8081
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License NumberAT0000000247
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: