Provider Demographics
NPI:1083981047
Name:BARRAZA, JEANINE (DPT)
Entity Type:Individual
Prefix:DR
First Name:JEANINE
Middle Name:
Last Name:BARRAZA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2853 HIDDEN HARBOUR CT
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-3570
Mailing Address - Country:US
Mailing Address - Phone:305-510-0378
Mailing Address - Fax:954-744-4024
Practice Address - Street 1:2853 HIDDEN HARBOUR CT
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-3570
Practice Address - Country:US
Practice Address - Phone:305-510-0378
Practice Address - Fax:954-744-4024
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT26962225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist