Provider Demographics
NPI:1669453353
Name:BARRUS, DEAN MILTON (PT)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:MILTON
Last Name:BARRUS
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 1:9430 NE VANCOUVER MALL DRIVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662
Mailing Address - Country:US
Mailing Address - Phone:360-256-9827
Mailing Address - Fax:360-256-9547
Practice Address - Street 1:9430 NE VANCOUVER MALL DRIVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662
Practice Address - Country:US
Practice Address - Phone:360-256-9827
Practice Address - Fax:360-256-9547
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2950225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA000615014Medicare ID - Type Unspecified