Provider Demographics
NPI:1104947423
Name:BARRY, EDWARD (PTA)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:BARRY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10341 SE US HIGHWAY 441
Mailing Address - Street 2:
Mailing Address - City:BELLEVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:34420-2807
Mailing Address - Country:US
Mailing Address - Phone:352-307-0066
Mailing Address - Fax:352-307-9556
Practice Address - Street 1:10341 SE US HIGHWAY 441
Practice Address - Street 2:
Practice Address - City:BELLEVIEW
Practice Address - State:FL
Practice Address - Zip Code:34420-2807
Practice Address - Country:US
Practice Address - Phone:352-307-0066
Practice Address - Fax:352-307-9556
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 12511225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant