Provider Demographics
NPI:1720434376
Name:BARRERA III, EDIBERTO
Entity Type:Individual
Prefix:
First Name:EDIBERTO
Middle Name:
Last Name:BARRERA III
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 681478
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-1478
Mailing Address - Country:US
Mailing Address - Phone:615-591-6590
Mailing Address - Fax:615-591-6601
Practice Address - Street 1:404 N CASTLE HEIGHTS AVE
Practice Address - Street 2:SUITE G
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-1511
Practice Address - Country:US
Practice Address - Phone:615-443-4938
Practice Address - Fax:615-443-4151
Is Sole Proprietor?:No
Enumeration Date:2016-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10730225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0446631Medicare PIN