Provider Demographics
NPI:1497336374
Name:BARRON, JACQUELINE MCPHERSON (PT, DPT)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:MCPHERSON
Last Name:BARRON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7218 N. ACADEMY BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-3187
Mailing Address - Country:US
Mailing Address - Phone:719-505-7510
Mailing Address - Fax:719-505-7229
Practice Address - Street 1:7218 N. ACADEMY BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920
Practice Address - Country:US
Practice Address - Phone:719-505-7510
Practice Address - Fax:719-505-7229
Is Sole Proprietor?:No
Enumeration Date:2021-04-21
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021044741225100000X
KS11-06753225100000X
CO19820225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist