=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730917998
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNIFER KAY BARNETT PTA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2024
-----------------------------------------------------
Last Update Date | 07/22/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4524 E HEREFORD RD
-----------------------------------------------------
City | HEREFORD
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85615-8813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-432-8205
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 432 S DESERT WILLOW PL
-----------------------------------------------------
City | BENSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85602-7503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-227-7425
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | PTA-014405
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------