Provider Demographics
NPI:1568172138
Name:BARKER, JERMAINE THEODORE (LMT)
Entity Type:Individual
Prefix:
First Name:JERMAINE
Middle Name:THEODORE
Last Name:BARKER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 S 8TH AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-4316
Mailing Address - Country:US
Mailing Address - Phone:646-361-2253
Mailing Address - Fax:
Practice Address - Street 1:631 S 8TH AVE FL 1
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-4316
Practice Address - Country:US
Practice Address - Phone:646-361-2253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032028225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist