Provider Demographics
NPI:1205870433
Name:BARRETT, JOHN JEROME (MS, ATC, CES)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:JEROME
Last Name:BARRETT
Suffix:
Gender:M
Credentials:MS, ATC, CES
Other - Prefix:
Other - First Name:JB
Other - Middle Name:
Other - Last Name:BARRETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, ATC, CES
Mailing Address - Street 1:5316 ZAMORA DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-3520
Mailing Address - Country:US
Mailing Address - Phone:314-200-9540
Mailing Address - Fax:
Practice Address - Street 1:633 EMERSON RD STE 20
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-6739
Practice Address - Country:US
Practice Address - Phone:314-325-3068
Practice Address - Fax:314-325-3069
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 18242255A2300X
MO20170317892255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2017031789OtherSTATE OF MISSOURI ATHLETIC TRAINER LICENSE
069702613OtherNATA BOC CERTIFICATION