Provider Demographics
NPI:1205125192
Name:CLEAVER, BARRY (PTA)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:
Last Name:CLEAVER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 DELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:WARMINSTER
Mailing Address - State:PA
Mailing Address - Zip Code:18974-3750
Mailing Address - Country:US
Mailing Address - Phone:215-674-9801
Mailing Address - Fax:
Practice Address - Street 1:2630 WOODLAND RD
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:PA
Practice Address - Zip Code:19001-3013
Practice Address - Country:US
Practice Address - Phone:215-881-4111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI000251314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility