Provider Demographics
NPI:1629294574
Name:BARRY, MARLENE ANN (PT)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:ANN
Last Name:BARRY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARLENE
Other - Middle Name:HORN
Other - Last Name:BARRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:1217 PLOVER CIRCLE
Mailing Address - Street 2:
Mailing Address - City:PONDER
Mailing Address - State:TX
Mailing Address - Zip Code:76259
Mailing Address - Country:US
Mailing Address - Phone:940-479-2840
Mailing Address - Fax:
Practice Address - Street 1:1208 BENTOAKS CT
Practice Address - Street 2:INFANT AND TODDLER INTERVENTION PROGRAM ECI
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210
Practice Address - Country:US
Practice Address - Phone:940-536-1192
Practice Address - Fax:940-536-1195
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1059053225100000X
OK482225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist