Provider Demographics
NPI:1427935840
Name:BARNES, NATHAN ANTHONY
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:ANTHONY
Last Name:BARNES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 E ERIE ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-6159
Mailing Address - Country:US
Mailing Address - Phone:414-272-8482
Mailing Address - Fax:414-272-2880
Practice Address - Street 1:10460 W INNOVATION DR STE 102
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-4881
Practice Address - Country:US
Practice Address - Phone:414-563-1230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-18
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17491-24225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist