Provider Demographics
NPI:1407196132
Name:BARNETT, SHAUNTESSA M (MPT)
Entity Type:Individual
Prefix:
First Name:SHAUNTESSA
Middle Name:M
Last Name:BARNETT
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7820 RYDAL TER
Mailing Address - Street 2:
Mailing Address - City:DERWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20855-2058
Mailing Address - Country:US
Mailing Address - Phone:732-718-5748
Mailing Address - Fax:
Practice Address - Street 1:7820 RYDAL TER
Practice Address - Street 2:
Practice Address - City:DERWOOD
Practice Address - State:MD
Practice Address - Zip Code:20855-2058
Practice Address - Country:US
Practice Address - Phone:732-718-5748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-16
Last Update Date:2013-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24378225100000X
NJ40QA01416100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist