Provider Demographics
NPI:1144341926
Name:BARAKATT, EDWARD T (PT)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:T
Last Name:BARAKATT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-2619
Mailing Address - Country:US
Mailing Address - Phone:530-753-5338
Mailing Address - Fax:530-753-4609
Practice Address - Street 1:1340 LAKE BLVD
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-2619
Practice Address - Country:US
Practice Address - Phone:530-753-5338
Practice Address - Fax:530-753-4609
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT10933225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist