Provider Demographics
NPI:1043439029
Name:BARTON, BENJAMIN JASON (MPT)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:JASON
Last Name:BARTON
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16075 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:ELLISVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2103
Mailing Address - Country:US
Mailing Address - Phone:636-256-0880
Mailing Address - Fax:636-256-9153
Practice Address - Street 1:16075 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:ELLISVILLE
Practice Address - State:MO
Practice Address - Zip Code:63011-2103
Practice Address - Country:US
Practice Address - Phone:636-256-0880
Practice Address - Fax:636-256-9153
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004030104225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO705347OtherUHC
MO724945OtherHEALTHLINK
MO185215OtherBCBS
MO705347OtherUHC