1306114715 NPI number — MARTINE BARRE DPT

Table of content: MARTINE BARRE DPT (NPI 1306114715)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306114715 NPI number — MARTINE BARRE DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARRE
Provider First Name:
MARTINE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ST.GERMAIN
Provider Other First Name:
MARTINE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1306114715
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6420 SEMINOLE TRL
Provider Second Line Business Mailing Address:
L4
Provider Business Mailing Address City Name:
BARBOURSVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22923-2836
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-939-9524
Provider Business Mailing Address Fax Number:
434-939-9679

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6420 SEMINOLE TRL
Provider Second Line Business Practice Location Address:
L4
Provider Business Practice Location Address City Name:
BARBOURSVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22923-2836
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-939-9524
Provider Business Practice Location Address Fax Number:
434-939-9679
Provider Enumeration Date:
12/13/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  6072 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208100000X , with the licence number: 2305208770 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)