Provider Demographics
NPI:1063501229
Name:BARIEL, KEN IVAN (PT)
Entity type:Individual
Prefix:
First Name:KEN
Middle Name:IVAN
Last Name:BARIEL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA
Mailing Address - State:CA
Mailing Address - Zip Code:93428-2820
Mailing Address - Country:US
Mailing Address - Phone:805-924-1605
Mailing Address - Fax:805-924-1603
Practice Address - Street 1:900 MAIN ST
Practice Address - Street 2:
Practice Address - City:CAMBRIA
Practice Address - State:CA
Practice Address - Zip Code:93428-2820
Practice Address - Country:US
Practice Address - Phone:805-924-1605
Practice Address - Fax:805-924-1603
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT5574225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist