Provider Demographics
NPI:1134221617
Name:BARANICK, JERRY (DPT)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:
Last Name:BARANICK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5122 CASA LOMA AVE
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-3943
Mailing Address - Country:US
Mailing Address - Phone:714-724-2575
Mailing Address - Fax:714-993-9878
Practice Address - Street 1:5122 CASA LOMA AVE
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-3943
Practice Address - Country:US
Practice Address - Phone:714-724-2575
Practice Address - Fax:714-993-9878
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA244152251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT24415DMedicare PIN