Provider Demographics
NPI:1124417399
Name:BARKER, CONNIE
Entity Type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:
Last Name:BARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21899 VALLEY RANCH CROSSING DR
Mailing Address - Street 2:APT 434
Mailing Address - City:PORTER
Mailing Address - State:TX
Mailing Address - Zip Code:77365-5496
Mailing Address - Country:US
Mailing Address - Phone:337-764-7366
Mailing Address - Fax:
Practice Address - Street 1:21650 LOOP 494
Practice Address - Street 2:
Practice Address - City:NEW CANEY
Practice Address - State:TX
Practice Address - Zip Code:77357-8240
Practice Address - Country:US
Practice Address - Phone:281-577-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT51242255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer