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General NPI Number Information
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NPI Number | 1821497009
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Entity Type | Individual
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Provider Name | CHAD D BARRETT EDD, ATC, LAT
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Gender | Male
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Dates
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Enumeration Date | 08/14/2014
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Last Update Date | 08/14/2014
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Provider Practice Location Address
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Address Line | 2615 JEFFERSON DR
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City | LIBERTY
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State | TX
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Zip | 77575-4311
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Country | US
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Telephone | 936-336-6483
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Fax | 936-336-7194
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Provider Business Mailing Address
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Address Line | 142 COUNTY ROAD 2088
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City | LIBERTY
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State | TX
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Zip | 77575-8003
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Country | US
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Telephone | 936-298-2176
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number | AT1213
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License Number State | TX
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