Provider Demographics
NPI:1306170725
Name:BARNES, MICHELLE ANN (PTA)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANN
Last Name:BARNES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5398 E CRESTHILL DR
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-1213
Mailing Address - Country:US
Mailing Address - Phone:713-777-4129
Mailing Address - Fax:
Practice Address - Street 1:5398 E CRESTHILL DR
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-1213
Practice Address - Country:US
Practice Address - Phone:713-777-4129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT 6709225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant