Provider Demographics
NPI:1225581028
Name:BARATA, KEVIN (PT)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:BARATA
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 1:6482 EMERALD DUNES DR
Mailing Address - Street 2:APT 207
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-2748
Mailing Address - Country:US
Mailing Address - Phone:484-666-7770
Mailing Address - Fax:
Practice Address - Street 1:4109 SHANNON AVE
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-4523
Practice Address - Country:US
Practice Address - Phone:484-666-7770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-27
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT31405225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist