Provider Demographics
NPI:1235111352
Name:BARRIOS, TARAH (PT)
Entity Type:Individual
Prefix:
First Name:TARAH
Middle Name:
Last Name:BARRIOS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:TARAH
Other - Middle Name:L
Other - Last Name:STREET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT DPT
Mailing Address - Street 1:6438 WILMINGTON PIKE
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-7022
Mailing Address - Country:US
Mailing Address - Phone:937-558-3810
Mailing Address - Fax:
Practice Address - Street 1:6438 WILMINGTON PIKE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-7022
Practice Address - Country:US
Practice Address - Phone:937-558-3810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT 012569225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000041626Medicaid
DE0000041626Medicaid
DE021212D48Medicare PIN