Provider Demographics
NPI:1679219091
Name:BARRETT, JAMES KEAGAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:KEAGAN
Last Name:BARRETT
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 N 52ND ST APT 2237
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-7956
Mailing Address - Country:US
Mailing Address - Phone:712-592-0576
Mailing Address - Fax:
Practice Address - Street 1:1025 E BROADWAY RD STE 101
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1535
Practice Address - Country:US
Practice Address - Phone:480-829-0217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-09
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2251X0800X
AZ32387225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic