Provider Demographics
NPI:1285199067
Name:BARNWELL, DANTE (PTA)
Entity Type:Individual
Prefix:
First Name:DANTE
Middle Name:
Last Name:BARNWELL
Suffix:
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 1:100 VETERANS MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:BOULDER CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89005-1926
Mailing Address - Country:US
Mailing Address - Phone:888-531-2201
Mailing Address - Fax:855-232-8604
Practice Address - Street 1:100 VETERANS MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:BOULDER CITY
Practice Address - State:NV
Practice Address - Zip Code:89005-1926
Practice Address - Country:US
Practice Address - Phone:888-531-2201
Practice Address - Fax:855-232-8604
Is Sole Proprietor?:No
Enumeration Date:2019-02-05
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVA1017225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant