Healthcare Provider Details

I. General information

NPI: 1417639154
Provider Name (Legal Business Name): COLIN BARKER MS, LAT, ATC, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2023
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 S VIEW DR STE 15132
MOSINEE WI
54455-8205
US

IV. Provider business mailing address

1200 RIVER VIEW AVE APT 21
STEVENS POINT WI
54481-5146
US

V. Phone/Fax

Practice location:
  • Phone: 715-298-2104
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: