MEDICARE: JOHNATHAN BARRY DPT

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	054312	NY

General Provider Information

NPI Number	:	1952259640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHNATHAN BARRY DPT

Provider Business Mailing Address
First Line	:	699 OCEAN AVE APT 1A
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-4932
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	699 OCEAN AVE APT 1A
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-4932
Country	:	US
Telephone Number	:	315-325-6535
Fax Number	:

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

Provider Enumeration Date	:	03/18/2026
Last Update Date	:	03/18/2026

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