Provider Demographics
NPI:1568423887
Name:FITCH, BARRY E (DPT)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:E
Last Name:FITCH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 HENDERSON ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2619
Mailing Address - Country:US
Mailing Address - Phone:803-758-2602
Mailing Address - Fax:803-253-8896
Practice Address - Street 1:100 JIMMY LOVE LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-3159
Practice Address - Country:US
Practice Address - Phone:803-731-4055
Practice Address - Fax:803-798-3335
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC883225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH0005Medicaid
R75026Medicare UPIN
SCTH0005Medicaid