Provider Demographics
NPI:1063501229
Name:BARIEL, KEN (PT)
Entity Type:Individual
Prefix:
First Name:KEN
Middle Name:
Last Name:BARIEL
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 1:795 FARMERS LN
Mailing Address - Street 2:STE 10
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-6718
Mailing Address - Country:US
Mailing Address - Phone:707-571-7615
Mailing Address - Fax:707-571-7615
Practice Address - Street 1:6574 OAKMONT DR
Practice Address - Street 2:STE D
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-5958
Practice Address - Country:US
Practice Address - Phone:707-539-5256
Practice Address - Fax:707-539-5256
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT5574225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist