Provider Demographics
NPI:1154368777
Name:BARNETT, PAUL STEVEN (PT)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:STEVEN
Last Name:BARNETT
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 1:4000 N PROVIDENCE AVE
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-8018
Mailing Address - Country:US
Mailing Address - Phone:920-257-2005
Mailing Address - Fax:920-257-2004
Practice Address - Street 1:612B E LONGVIEW DR
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-2149
Practice Address - Country:US
Practice Address - Phone:920-968-0814
Practice Address - Fax:920-734-6159
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2690-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI64-05777OtherMEDICA-LADYSMITH
WI650007189OtherRAILROAD MEDICARE/GREENBA
WI40071300Medicaid
WI64-03835OtherMEDICA/ASHLAND
WV650019401OtherRAILROAD MEDICARE/APPLETO
WI113455OtherSECURITY HEALTH PLAN-ASHLAND/POPLAR
WI122438OtherSECURITY HEALTH PLAN-WAUPACA
WI650023986OtherRAILROAD MEDICARE/CLINTON
WI100910OtherSECURITY HEALTH GROUP
WI650019401OtherRAILROAD MEDICARE/MENASHA
WI100910OtherSECURITY HEALTH PLAN-LADYSMITH
WI509S4BAOtherBCBS OF MN
WI64-03834OtherMEDICA-POPLAR
WIP00460919OtherRAILROAD MEDICARE/NEW LONDON
WIP00004500OtherRAILROAD MEDICARE/POPLAR
WI000386021Medicare ID - Type Unspecified
WI000486652Medicare ID - Type Unspecified
WI000186160Medicare ID - Type Unspecified
WI40071300Medicaid
WI000186519Medicare ID - Type Unspecified
WI509S4BAOtherBCBS OF MN
WI650023986OtherRAILROAD MEDICARE/CLINTON
WI100910OtherSECURITY HEALTH PLAN-LADYSMITH
WI100910OtherSECURITY HEALTH GROUP
WI000686020Medicare ID - Type Unspecified