Provider Demographics
NPI:1336100692
Name:BARR, JACOB COREY (DPT, MTC)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:COREY
Last Name:BARR
Suffix:
Gender:M
Credentials:DPT, MTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:33 ORMOND GREEN BLVD
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-8768
Mailing Address - Country:US
Mailing Address - Phone:386-299-3192
Mailing Address - Fax:386-673-3530
Practice Address - Street 1:1425 HAND AVE
Practice Address - Street 2:SUITE H
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-1135
Practice Address - Country:US
Practice Address - Phone:386-673-3535
Practice Address - Fax:386-673-3530
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT18544225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist