Provider Demographics
NPI:1104936863
Name:DIKES, BARRY (MPT)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:
Last Name:DIKES
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6913 CAMP BOWIE BLVD
Mailing Address - Street 2:#107
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-7163
Mailing Address - Country:US
Mailing Address - Phone:817-737-0006
Mailing Address - Fax:
Practice Address - Street 1:6913 CAMP BOWIE BLVD
Practice Address - Street 2:#107
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-7163
Practice Address - Country:US
Practice Address - Phone:817-737-0006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1098580OtherLICENSE #
TX1098580OtherLICENSE #