Provider Demographics
NPI:1659485050
Name:BARNUM, JARED P (PT)
Entity Type:Individual
Prefix:MR
First Name:JARED
Middle Name:P
Last Name:BARNUM
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5527 W. ANDREA DR.
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85083-2359
Mailing Address - Country:US
Mailing Address - Phone:623-670-6444
Mailing Address - Fax:
Practice Address - Street 1:6320A W UNION HILLS DR
Practice Address - Street 2:SUITE 265
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-7177
Practice Address - Country:US
Practice Address - Phone:623-374-2424
Practice Address - Fax:623-374-2619
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6872225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ106734Medicare ID - Type UnspecifiedMEDICARE PART B