Provider Demographics
NPI:1326108374
Name:BARKER, CHARLES B III (DPT, OCS, ATC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:B
Last Name:BARKER
Suffix:III
Gender:M
Credentials:DPT, OCS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 S GOVERNORS AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-6901
Mailing Address - Country:US
Mailing Address - Phone:302-730-4800
Mailing Address - Fax:302-730-8040
Practice Address - Street 1:1015 S GOVERNORS AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-6901
Practice Address - Country:US
Practice Address - Phone:302-730-4800
Practice Address - Fax:302-730-8040
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0000614225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000028606Medicaid
DEG01417B01Medicare PIN