Provider Demographics
NPI:1730917998
Name:BARNETT, JENNIFER KAY (PTA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KAY
Last Name:BARNETT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 S DESERT WILLOW PL
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85602-7503
Mailing Address - Country:US
Mailing Address - Phone:520-227-7425
Mailing Address - Fax:
Practice Address - Street 1:4524 E HEREFORD RD
Practice Address - Street 2:
Practice Address - City:HEREFORD
Practice Address - State:AZ
Practice Address - Zip Code:85615-8813
Practice Address - Country:US
Practice Address - Phone:520-432-8205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPTA-014405225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant