Provider Demographics
NPI:1215980339
Name:BARRETT, GEORGE (PT)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:
Last Name:BARRETT
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 1:231 WALTON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-1230
Mailing Address - Country:US
Mailing Address - Phone:315-478-0380
Mailing Address - Fax:315-478-0388
Practice Address - Street 1:6800 E GENESEE ST
Practice Address - Street 2:SUITE A
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-1089
Practice Address - Country:US
Practice Address - Phone:315-478-0380
Practice Address - Fax:315-478-0388
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020527-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02845572Medicaid
NYRB1869Medicare PIN
NYRB1868Medicare PIN