Provider Demographics
NPI:1811036916
Name:BARRESSE, JOHN STEVEN JR (MS ATC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:STEVEN
Last Name:BARRESSE
Suffix:JR
Gender:M
Credentials:MS ATC
Other - Prefix:MR
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:BARRESSE
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:JOHN BARRESSE
Mailing Address - Street 1:8960 SE TOLBERT ST
Mailing Address - Street 2:UNIT 1
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-9654
Mailing Address - Country:US
Mailing Address - Phone:503-969-4445
Mailing Address - Fax:
Practice Address - Street 1:160 NW 2ND AVE
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-3729
Practice Address - Country:US
Practice Address - Phone:503-263-6786
Practice Address - Fax:503-263-6451
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORATAT10058962255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer