Provider Demographics
NPI:1326196189
Name:BARKER, KEITHA RENAY IV
Entity Type:Individual
Prefix:MRS
First Name:KEITHA
Middle Name:RENAY
Last Name:BARKER
Suffix:IV
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 CEDAR CT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:AL
Mailing Address - Zip Code:36250-5110
Mailing Address - Country:US
Mailing Address - Phone:256-820-7268
Mailing Address - Fax:256-832-2004
Practice Address - Street 1:2300 COLEMAN RD
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-6824
Practice Address - Country:US
Practice Address - Phone:256-831-5730
Practice Address - Fax:256-832-2004
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTA3682225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant