Provider Demographics
NPI:1699931287
Name:BARTA, JEFFREY PAUL (ATC)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:PAUL
Last Name:BARTA
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 S COLUMBIA RD
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-4039
Mailing Address - Country:US
Mailing Address - Phone:701-746-8374
Mailing Address - Fax:701-780-0885
Practice Address - Street 1:1425 S COLUMBIA RD
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4039
Practice Address - Country:US
Practice Address - Phone:701-746-8374
Practice Address - Fax:701-780-0885
Is Sole Proprietor?:No
Enumeration Date:2008-08-03
Last Update Date:2008-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND050-872255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer