Provider Demographics
NPI:1548524440
Name:BARNES PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:BARNES PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:DR
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:208-681-3757
Mailing Address - Street 1:286 WILLIS ST
Mailing Address - Street 2:
Mailing Address - City:BLACKFOOT
Mailing Address - State:ID
Mailing Address - Zip Code:83221-3362
Mailing Address - Country:US
Mailing Address - Phone:208-681-3757
Mailing Address - Fax:
Practice Address - Street 1:1250 W BRIDGE ST
Practice Address - Street 2:
Practice Address - City:BLACKFOOT
Practice Address - State:ID
Practice Address - Zip Code:83221-5095
Practice Address - Country:US
Practice Address - Phone:208-681-3757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-26
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-3009225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty