Provider Demographics
NPI:1457771487
Name:BARKER PHYSICAL THERAPY CLINIC SC
Entity Type:Organization
Organization Name:BARKER PHYSICAL THERAPY CLINIC SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:L
Authorized Official - Last Name:BARKER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:715-938-6030
Mailing Address - Street 1:2724 CAHILL RD
Mailing Address - Street 2:
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-3869
Mailing Address - Country:US
Mailing Address - Phone:715-938-6030
Mailing Address - Fax:715-330-5807
Practice Address - Street 1:2724 CAHILL RD
Practice Address - Street 2:
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-3869
Practice Address - Country:US
Practice Address - Phone:715-330-5547
Practice Address - Fax:715-330-5807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-17
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10138-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty