Provider Demographics
NPI:1881834737
Name:BARNES, MARISSA (PTA)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:BARNES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8747 BIG BEND BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-3729
Mailing Address - Country:US
Mailing Address - Phone:314-968-4044
Mailing Address - Fax:314-963-0787
Practice Address - Street 1:8747 BIG BEND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-3729
Practice Address - Country:US
Practice Address - Phone:314-968-4044
Practice Address - Fax:314-963-0787
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-04
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO117492225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant