Provider Demographics
NPI:1700975661
Name:KLONSKY, BARRY J (RPT)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:J
Last Name:KLONSKY
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24482 MOONFIRE DR
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-1766
Mailing Address - Country:US
Mailing Address - Phone:949-285-5663
Mailing Address - Fax:
Practice Address - Street 1:23232 PERALTA DR STE 113
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1436
Practice Address - Country:US
Practice Address - Phone:949-922-2776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5025225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMO115574Medicare ID - Type Unspecified