Provider Demographics
NPI:1750359717
Name:BARRETT, STEPHEN CYRIL (ATC/L)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:CYRIL
Last Name:BARRETT
Suffix:
Gender:M
Credentials:ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SAINT CLAIR CIR
Mailing Address - Street 2:APT C
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23693-4166
Mailing Address - Country:US
Mailing Address - Phone:757-223-4967
Mailing Address - Fax:
Practice Address - Street 1:300 BUTLER FARM RD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-1522
Practice Address - Country:US
Practice Address - Phone:757-766-2658
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260009672255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer