Provider Demographics
NPI:1225060635
Name:DORKO, BARRETT L (PT)
Entity Type:Individual
Prefix:
First Name:BARRETT
Middle Name:L
Last Name:DORKO
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 1:503 PORTAGE TRL
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-3229
Mailing Address - Country:US
Mailing Address - Phone:330-929-1119
Mailing Address - Fax:330-929-1491
Practice Address - Street 1:503 PORTAGE TRL
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-3229
Practice Address - Country:US
Practice Address - Phone:330-929-1119
Practice Address - Fax:330-929-1491
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2661225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH712921Medicare ID - Type Unspecified