Provider Demographics
NPI:1063431864
Name:BARCENAS, DAVE PAUL (MSPT)
Entity type:Individual
Prefix:
First Name:DAVE
Middle Name:PAUL
Last Name:BARCENAS
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:536 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-3339
Mailing Address - Country:US
Mailing Address - Phone:509-522-4271
Mailing Address - Fax:
Practice Address - Street 1:214 E BIRCH ST
Practice Address - Street 2:SUITE 4
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-3043
Practice Address - Country:US
Practice Address - Phone:509-522-0114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00006431225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist