Provider Demographics
NPI:1124629043
Name:BARRINO, NATHANIEL FARNSWORTH (MT)
Entity type:Individual
Prefix:MR
First Name:NATHANIEL
Middle Name:FARNSWORTH
Last Name:BARRINO
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21940 COOLIDGE HWY
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2811
Mailing Address - Country:US
Mailing Address - Phone:248-636-6386
Mailing Address - Fax:
Practice Address - Street 1:21940 COOLIDGE HWY
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2811
Practice Address - Country:US
Practice Address - Phone:248-636-6386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501010302225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist