Provider Demographics
NPI:1760601009
Name:BARNETT, NANCY LYNN (LPTA)
Entity Type:Individual
Prefix:MISS
First Name:NANCY
Middle Name:LYNN
Last Name:BARNETT
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62226-7572
Mailing Address - Country:US
Mailing Address - Phone:618-799-9130
Mailing Address - Fax:
Practice Address - Street 1:11701 BORMAN DR STE 280
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-4199
Practice Address - Country:US
Practice Address - Phone:314-983-9555
Practice Address - Fax:314-983-9444
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO116309225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant