Provider Demographics
NPI:1730288382
Name:BAREKMAN, LORI (PT)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:
Last Name:BAREKMAN
Suffix:
Gender:F
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:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CA
Mailing Address - Zip Code:95492-0010
Mailing Address - Country:US
Mailing Address - Phone:707-837-7980
Mailing Address - Fax:707-837-7983
Practice Address - Street 1:5803 SKYLANE BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:WINDSOR
Practice Address - State:CA
Practice Address - Zip Code:95492-6836
Practice Address - Country:US
Practice Address - Phone:707-837-7980
Practice Address - Fax:707-837-7983
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT13897225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT13897OtherCA LICENSE