Provider Demographics
NPI:1912974650
Name:BARNES, ROBERT M (DPT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:BARNES
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16083 SW UPPER BOONES FERRY RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7736
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-639-9699
Practice Address - Street 1:415 E PARKCENTER BLVD
Practice Address - Street 2:STE 114
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-6504
Practice Address - Country:US
Practice Address - Phone:208-336-8433
Practice Address - Fax:208-336-8441
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008420225100000X
CA23604225100000X
IDRPT1786225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806686000Medicaid
IDP00061313OtherRR MEDICARE
ID0330315OtherWA L&I
ID1912974650-000Medicaid
ID1912974650Medicaid
ID1912974650-000Medicaid