Provider Demographics
NPI:1821497009
Name:BARRETT, CHAD D (EDD, ATC, LAT)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:D
Last Name:BARRETT
Suffix:
Gender:M
Credentials:EDD, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 COUNTY ROAD 2088
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:TX
Mailing Address - Zip Code:77575-8003
Mailing Address - Country:US
Mailing Address - Phone:936-298-2176
Mailing Address - Fax:
Practice Address - Street 1:2615 JEFFERSON DR
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:TX
Practice Address - Zip Code:77575-4311
Practice Address - Country:US
Practice Address - Phone:936-336-6483
Practice Address - Fax:936-336-7194
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT1213171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor