Provider Demographics
NPI:1942220348
Name:BARNETTE, SALLY J (PT)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:J
Last Name:BARNETTE
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 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-446-5387
Mailing Address - Fax:740-446-5982
Practice Address - Street 1:1051 4TH AVE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631
Practice Address - Country:US
Practice Address - Phone:740-446-5244
Practice Address - Fax:740-446-5448
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH09294225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000217253OtherANTHEM BCBS
001714139OtherMOUNTAIN STATE BCBS
000000204410OtherOH - MEDICAID UNISON
650019719OtherRR MEDICARE
OH2226899OtherMOLINA MEDICAID
WV7305045000Medicaid
OH2226899Medicaid
000000204410OtherOH - MEDICAID UNISON