=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801072517
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BARR & ASSOCIATES PHYSICAL THERAPY,LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2008
-----------------------------------------------------
Last Update Date | 07/25/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1425 HAND AVE SUITE H
-----------------------------------------------------
City | ORMOND BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32174
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-673-3535
-----------------------------------------------------
Fax | 386-673-3530
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1425 HAND AVE SUITE H
-----------------------------------------------------
City | ORMOND BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32174-1135
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-673-3535
-----------------------------------------------------
Fax | 386-673-3530
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | DR. JACOB COREY BARR
-----------------------------------------------------
Credential | DPT, MTC,CEAS
-----------------------------------------------------
Telephone | 386-299-3192
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------