MEDICARE: MR. BARTON DRAKE IBSEN P.T.

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	225100000X	Physical Therapist	PTH3156	AL

General Provider Information

NPI Number	:	1417951112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BARTON DRAKE IBSEN P.T.

Provider Business Mailing Address
First Line	:	121 DRINKARD DR NW
Second Line	:
City	:	FORT PAYNE
State	:	AL
Zip	:	35967-3758
Country	:	US
Telephone Number	:	256-997-9006
Fax Number	:	256-997-9006

Provider Business Practice Location Address
First Line	:	121 DRINKARD DR
Second Line	:
City	:	FORT PAYNE
State	:	AL
Zip	:	35967
Country	:	US
Telephone Number	:	256-997-9006
Fax Number	:	256-997-0606

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	02/20/2025

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