Provider Demographics
NPI:1285032292
Name:BARAINYAK, JACQUELINE (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:BARAINYAK
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 BRITAIN WOOD CIR
Mailing Address - Street 2:
Mailing Address - City:CHALFONT
Mailing Address - State:PA
Mailing Address - Zip Code:18914-1811
Mailing Address - Country:US
Mailing Address - Phone:267-266-0735
Mailing Address - Fax:
Practice Address - Street 1:111 BRITAIN WOOD CIR
Practice Address - Street 2:
Practice Address - City:CHALFONT
Practice Address - State:PA
Practice Address - Zip Code:18914-1811
Practice Address - Country:US
Practice Address - Phone:267-266-0735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-08
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0051422255A2300X
DEJ3-00004252255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer