Provider Demographics
NPI:1225671951
Name:BARNHART, MICHELLE LEE (PTA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEE
Last Name:BARNHART
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1739 ELM CT STE 206
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65101-4303
Mailing Address - Country:US
Mailing Address - Phone:573-681-0447
Mailing Address - Fax:573-681-0445
Practice Address - Street 1:1739 ELM CT STE 206
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-4303
Practice Address - Country:US
Practice Address - Phone:573-681-0447
Practice Address - Fax:573-681-0445
Is Sole Proprietor?:No
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019039368225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant