Provider Demographics
NPI:1578269478
Name:BARNES, GREGORY DEVON
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:DEVON
Last Name:BARNES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5041 GUAVA AVE
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-8258
Mailing Address - Country:US
Mailing Address - Phone:619-916-6381
Mailing Address - Fax:
Practice Address - Street 1:5696 LAKE MURRAY BLVD
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-1929
Practice Address - Country:US
Practice Address - Phone:619-460-7871
Practice Address - Fax:619-460-4810
Is Sole Proprietor?:No
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant