Provider Demographics
NPI:1154721249
Name:BARNES, JARED WAYNES (PT DPT)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:WAYNES
Last Name:BARNES
Suffix:
Gender:M
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4040 BRYCE LN
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75077-7038
Mailing Address - Country:US
Mailing Address - Phone:940-241-1215
Mailing Address - Fax:
Practice Address - Street 1:6080 SOUTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76109-3912
Practice Address - Country:US
Practice Address - Phone:817-731-9331
Practice Address - Fax:817-731-9882
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-26
Last Update Date:2017-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1246937225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist