Provider Demographics
NPI:1225104904
Name:BARNES, WILLIAM R JR (PTA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:BARNES
Suffix:JR
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 E GUADALUPE RD
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-3273
Mailing Address - Country:US
Mailing Address - Phone:480-839-8552
Mailing Address - Fax:480-752-7978
Practice Address - Street 1:1855 E GUADALUPE RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-3273
Practice Address - Country:US
Practice Address - Phone:480-839-8552
Practice Address - Fax:480-752-7978
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA1988225200000X
WAP160197428225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant