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General NPI Number Information
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NPI Number | 1548524440
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Entity Type | Organization
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Legal Business Name | BARNES PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 06/26/2012
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Last Update Date | 09/17/2012
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Provider Practice Location Address
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Address Line | 1250 W BRIDGE ST
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City | BLACKFOOT
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State | ID
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Zip | 83221-5095
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Country | US
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Telephone | 208-681-3757
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Fax |
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Provider Business Mailing Address
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Address Line | 286 WILLIS ST
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City | BLACKFOOT
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State | ID
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Zip | 83221-3362
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Country | US
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Telephone | 208-681-3757
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF PHYSICAL THERAPY
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Name | DR. TREVOR GEORGE BARNES
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Credential | DPT
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Telephone | 208-681-3757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT-3009
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License Number State | ID
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