Provider Demographics
NPI:1902804651
Name:BARBOREK, LEIGH MERRITT (DPT)
Entity Type:Individual
Prefix:MRS
First Name:LEIGH
Middle Name:MERRITT
Last Name:BARBOREK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:GWENDOLYN
Other - Middle Name:LEIGH
Other - Last Name:MERRITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:144 HIGH ACRES DRIVE
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72802-7934
Mailing Address - Country:US
Mailing Address - Phone:479-967-9657
Mailing Address - Fax:479-967-9658
Practice Address - Street 1:144 HIGH DRIVE
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-7934
Practice Address - Country:US
Practice Address - Phone:479-967-9657
Practice Address - Fax:479-967-9658
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT1607225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR136075742Medicaid
AR5C105Medicare ID - Type UnspecifiedGROUP