Provider Demographics
NPI:1306994447
Name:BARNES, STEPHANIE NELSON (PT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:NELSON
Last Name:BARNES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:558 IRONWOOD GATE DR
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-4259
Mailing Address - Country:US
Mailing Address - Phone:304-425-2055
Mailing Address - Fax:
Practice Address - Street 1:8201 ATLEE RD
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-1815
Practice Address - Country:US
Practice Address - Phone:804-569-1787
Practice Address - Fax:804-569-9787
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203851225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist