MEDICARE: SELENA RENEE BAREFOOT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	2306601791	VA

General Provider Information

NPI Number	:	1063088193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SELENA RENEE BAREFOOT

Provider Business Mailing Address
First Line	:	42 BARCLAY LN
Second Line	:
City	:	STAFFORD
State	:	VA
Zip	:	22554-7724
Country	:	US
Telephone Number	:	703-479-4985
Fax Number	:

Provider Business Practice Location Address
First Line	:	14605 POTOMAC BRANCH DR
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22191-3336
Country	:	US
Telephone Number	:	703-490-1112
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2021
Last Update Date	:	05/30/2021

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Directions to “ SELENA RENEE BAREFOOT ” Practice Location

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